[ATSDR] Environmental Justice Index Workshop Feedback Surveys

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Documents and Forms

Document Name Document Type
Form 0923-0047 [ATSDR] Environmental Justice Index Workshop Feedback Surveys Form and Instruction
0923-0047 AttB EJI Breakout Session Survey (online) AttB EJI Breakout Session Survey (Word).docx Form and Instruction
0923-0047 AttC EJI Use Case Breakout Session Survey (Word) AttC EJI Use Case Breakout Session Survey (Word).docx Form and Instruction
0923-0047 AttD EJI Explorer Demo Session Survey (Word) AttD EJI Explorer Demo Session Survey (Word).docx Form and Instruction
AttB EJI Breakout Session Survey (online).pdf AttB EJI Breakout Session Survey (online) IC Document
AttC EJI Use Case Breakout Session Survey (online).pdf AttC EJI Use Case Breakout Session Survey (online) IC Document
AttD EJI Explorer Demo Survey (online).pdf AttD EJI Explorer Demo Survey (online) IC Document
0923-0047 GenIC_EJI_Wrkshp_Feedback_revised_signed.docx GenIC Request IC Document
AttE STARS Determination Form.pdf AttE STARS Determination Form IC Document

Information Collection (IC) Details

IC Title:	[ATSDR] Environmental Justice Index Workshop Feedback Surveys	Agency IC Tracking Number:	0923-0047-23CS

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0923-0047	AttB EJI Breakout Session Survey (online)	AttB EJI Breakout Session Survey (Word).docx	Yes	Yes	Fillable Fileable
Form and Instruction	0923-0047	AttC EJI Use Case Breakout Session Survey (Word)	AttC EJI Use Case Breakout Session Survey (Word).docx	Yes	Yes	Fillable Fileable
Form and Instruction	0923-0047	AttD EJI Explorer Demo Session Survey (Word)	AttD EJI Explorer Demo Session Survey (Word).docx	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,320	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,320	1,320
Annual IC Time Burden (Hours)	66	66
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
AttB EJI Breakout Session Survey (online)	AttB EJI Breakout Session Survey (online).pdf	02/27/2023
AttC EJI Use Case Breakout Session Survey (online)	AttC EJI Use Case Breakout Session Survey (online).pdf	02/27/2023
AttD EJI Explorer Demo Survey (online)	AttD EJI Explorer Demo Survey (online).pdf	02/27/2023
GenIC Request	0923-0047 GenIC_EJI_Wrkshp_Feedback_revised_signed.docx	02/27/2023
AttE STARS Determination Form	AttE STARS Determination Form.pdf	02/27/2023

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