Information Collection

[ATSDR] Environmental Justice Index Workshop Feedback Surveys

IC 258785 under ICR 202110-0923-002 · OMB 0923-0047.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0047 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.