Information Collection

Community Members - ACAS Hard Copy

IC 224872 under ICR 202012-0923-001 · OMB 0923-0055.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Community Members - ACAS Hard Copy	Form and Instruction
ATSDR Communication Activities Survey (ACAS hardcopy) AttF1 Hardcopy ACAS 20201130.docx	Form and Instruction
ATSDR Communication Activities Survey (ACAS hardcopy) AttF1 Hardcopy ACAS 20201130.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	ATSDR Communication Activities Survey (ACAS hardcopy)	AttF1 Hardcopy ACAS 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: 77

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	77	77
Annual IC Time Burden (Hours)	19	19
Annual IC Cost Burden (Dollars)	495	495

Documents for IC

table that charts IC Documents
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.