Community Members - Sign-In Sheet

ATSDR Communication Activities Survey (ACAS)

Documents and Forms

Document Name Document Type
Community Members - Sign-In Sheet Form and Instruction
ATSDR Public Meeting Survey Sign-In Sheet AttE ACAS Sign-in Sheet 20201130.docx Form and Instruction
ATSDR Public Meeting Survey Sign-In Sheet AttE ACAS Sign-in Sheet 20201130.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Community Members - Sign-In Sheet	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	ATSDR Public Meeting Survey Sign-In Sheet	AttE ACAS Sign-in Sheet 20201130.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 125	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	125	125
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	107	107

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.