Information Collection

Climate and Economic Justice Screening Tool-Site Satisfaction

IC 255751 under ICR 202206-0331-001 · OMB 0331-0004.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0331-0004-001 Climate and Economic Justice Screening Tool-Site Satisfaction	Form and Instruction
0331-0004-001 CEJST-Site Satisfaction Survey CEQ form 001_CEJST v1.0 Site Survey.docx	Form and Instruction
CEQ form 001_fast-track-PRA-submission--site-survey.docx Fast Track PRA Submission-CEJST Site Satisfaction Survey	IC Document

IC Title:

Agency IC Tracking Number:

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 and Instruction	0331-0004-001	CEJST-Site Satisfaction Survey	CEQ form 001_CEJST v1.0 Site Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	300	300
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track PRA Submission-CEJST Site Satisfaction Survey	CEQ form 001_fast-track-PRA-submission--site-survey.docx	09/07/2022

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