Information Collection

Diagnostic Services_Request_Form

IC 270438 under ICR 202201-1028-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Diagnostic Services_Request_Form	Form
Wildlife_Mortality_Reporting_and_Diagnostic_Services_Req WILDLI~1.PDF	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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	N/A	Wildlife_Mortality_Reporting_and_Diagnostic_Services_Request_Form_OMB	WILDLI~1.PDF		Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Environmental Remediation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 215

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	215	215
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

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.