Information Collection

Climate and Economic Justice Screening Tool-Data Survey

IC 255792 under ICR 202206-0331-001 · OMB 0331-0004.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0331-0004-002 CEJST-Data Survey Climate and Economic Justice Screening Tool-Data Survey	Form and Instruction
0331-0004-002 CEJST-Data Survey CEQ form 002_CEJST v1.0 Data Survey.docx	Form and Instruction
CEQ form 002_fast-track-PRA-submission-data-survey.docx PRA Fast Track-CEJST Data 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	0331-0004-002				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: 150

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	150	150
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
PRA Fast Track-CEJST Data Survey		09/09/2022

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

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