Environmental Information and Documentation Checklist

HRSA Environmental Information and Documentation (EID)

Documents and Forms

Document Name Document Type
Form 1 Environmental Information and Documentation Checklist Form
1 Environmental_checklist 2022 - (0324) - Feb 2022.docx FORM - environmental_checklist 2022 - (0324) - Feb 2022.docx Form
1 Environmental_checklist 2022 - (0324) - Feb 2022.docx FORM - environmental_checklist 2022 - (0324) - Feb 2022.docx Form

Information Collection (IC) Details

IC Title:	Environmental Information and Documentation Checklist	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Environmental_checklist 2022 - (0324) - Feb 2022.docx	FORM - environmental_checklist 2022 - (0324) - Feb 2022.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	1,500	1,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.