Information Collection

CORE-CM Environmental Justice Working Group - Survey 1

IC 259584 under ICR 202108-1910-003 · OMB 1910-5160.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1910-5160 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
EJ Working Group Survey 1.pdf	Other-Survey
CORE-CM Env Generic Clearance Submission Template.docx Generic Clearance Submission Form	IC Document
EJSR Working Group--Screenshots.docx Survey Screenshots	IC Document

IC Title:

CORE-CM Environmental Justice Working Group - Survey 1

Agency IC Tracking Number:

Travis Young

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
Other-Survey					Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Clearance Submission Form		04/07/2023
Survey Screenshots		04/07/2023

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

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