Information Collection

BQASP Data Submission Form

IC 255942 under ICR 202209-0920-008 · OMB 0920-1389.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1389 can be found here:

2026-02-23 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
BQASP Data Submission Form	Form
BQASP Data Submission Form Perchlorate BQASP Data Submission Form	Form
BQASP Data Submission Form Cotinine BQASP Data Submission Form	Form
BQASP Data Submission Form Pesticides BQASP Data Submission Form	Form
BQASP Data Submission Form PFAS BQASP Data Submission Form	Form
BQASP Data Submission Form Phenols BQASP Data Submission Form	Form
BQASP Data Submission Form Phthalates BQASP Data Submission Form	Form
BQASP Data Submission Form PAH BQASP Data Submission Form	Form
BQASP Data Submission Form Perchlorate Att 3i-I. BQASP DataReturn_CIO4-.xlsx	Form
BQASP Data Submission Form Perchlorate Att 3i-I. BQASP DataReturn_CIO4-.xlsx	Form
BQASP Data Submission Form Cotinine Att 3i-I. BQASP DataReturn_Cotinine.xlsx	Form
BQASP Data Submission Form Cotinine Att 3i-I. BQASP DataReturn_Cotinine.xlsx	Form
BQASP Data Submission Form Pesticides Att 3i-I. BQASP DataReturn_Pest.xlsx	Form
BQASP Data Submission Form Pesticides Att 3i-I. BQASP DataReturn_Pest.xlsx	Form
BQASP Data Submission Form PFAS Att 3i-I. BQASP DataReturn_PFAS.xlsx	Form
BQASP Data Submission Form PFAS Att 3i-I. BQASP DataReturn_PFAS.xlsx	Form
BQASP Data Submission Form Phenols Att 3i-I. BQASP DataReturn_Phenols.xlsx	Form
BQASP Data Submission Form Phenols Att 3i-I. BQASP DataReturn_Phenols.xlsx	Form
BQASP Data Submission Form Phthalates Att 3i-I. BQASP DataReturn_Phthal.xlsx	Form
BQASP Data Submission Form Phthalates Att 3i-I. BQASP DataReturn_Phthal.xlsx	Form
BQASP Data Submission Form PAH Att 3i-I. BQASP DataReturnForm_PAH.xlsx	Form
BQASP Data Submission Form PAH Att 3i-I. BQASP DataReturnForm_PAH.xlsx	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

BQASP Data Submission Form

Agency IC Tracking Number:

0920-22AW

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	n/a	BQASP Data Submission Form Perchlorate	Att 3i-I. BQASP DataReturn_CIO4-.xlsx	Yes	Yes	Fillable Fileable
Form	n/a	BQASP Data Submission Form Cotinine	Att 3i-I. BQASP DataReturn_Cotinine.xlsx	Yes	Yes	Fillable Fileable
Form	n/a	BQASP Data Submission Form Pesticides	Att 3i-I. BQASP DataReturn_Pest.xlsx	Yes	Yes	Fillable Fileable
Form	n/a	BQASP Data Submission Form PFAS	Att 3i-I. BQASP DataReturn_PFAS.xlsx	Yes	Yes	Fillable Fileable
Form	n/a	BQASP Data Submission Form Phenols	Att 3i-I. BQASP DataReturn_Phenols.xlsx	Yes	Yes	Fillable Fileable
Form	n/a	BQASP Data Submission Form Phthalates	Att 3i-I. BQASP DataReturn_Phthal.xlsx	Yes	Yes	Fillable Fileable
Form	n/a	BQASP Data Submission Form PAH	Att 3i-I. BQASP DataReturnForm_PAH.xlsx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
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
No associated records found

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