Information Collection

Community Members - ACAS Telephone

IC 224874 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 Telephone	Form and Instruction
ATSDR Community Activities Survey - Telephone AttF3 Telephone ACAS 20170612 clean.docx	Form and Instruction
ATSDR Community Activities Survey - Telephone AttF3 Telephone ACAS 20170612 clean.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	NA	ATSDR Community Activities Survey - Telephone	AttF3 Telephone ACAS 20170612 clean.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: Records of Persons Exposed or Potentially Exposed to Hazardous or Toxic Substances

FR Citation: 53 FR 30702

Number of Respondents: 6

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-6	6
Annual IC Time Burden (Hours)	-2	2
Annual IC Cost Burden (Dollars)	0	0

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.