Information Collection

Evaluating the Pilot Los Angeles Public Library Sensor Loan Program: Patron Air Sensor Use Component

IC 246188 under ICR 202012-2010-001 · OMB 2010-0042.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5800-013 Evaluating the Pilot Los Angeles Public Library Sensor Loan Program: Patron Air Sensor Use Component	Form
5800-013 Los Angeles Public Library Patron Air Sensor Loan Survey Patron Survey screenshots.docx	Form
5800-013 Los Angeles Public Library Patron Air Sensor Loan Survey Patron Survey screenshots.docx	Form
Generic Clearance Justific.docx Justification	IC Document
Generic Clearance Justific.docx Justification	IC Document

IC Title:

Agency IC Tracking Number:

2434.129

IC Status: New

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	5800-013	Los Angeles Public Library Patron Air Sensor Loan Survey	Patron Survey screenshots.docx		Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	1,800	1,800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification	Generic Clearance Justific.docx	03/11/2021

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