Information Collection

Agency Stakeholders - ACAS Sign-In Sheet

IC 224878 under ICR 202012-0923-001 · OMB 0923-0055.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Agency Stakeholders - ACAS Sign-In Sheet	Form
ATSDR Public Meeting Survey Sign-In Sheet AttE ACAS Sign-in Sheet 20201130.docx	Form
ATSDR Public Meeting Survey Sign-In Sheet AttE ACAS Sign-in Sheet 20201130.docx	Form

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	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: 42

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	42	42
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	53	53

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.