Information Collection

NIEHS Superfund Research Program (SRP) Data Collection Tool

IC 272299 under ICR 202307-0925-004 · OMB 0925-0766.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0766 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Data Collection Tool NIEHS Superfund Research Program (SRP) Data Collection Tool	Form
1 Data Collection Tool Attachment I NIEHS SRP Data Collection Tool.docx	Form
0925-0766 Template DERT SRP Grantee Data Collection.docx Template	IC Document
SRP Website Announcement.docx Website Announcement	IC Document

IC Title:

NIEHS Superfund Research Program (SRP) Data Collection Tool

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	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service

FR Citation: 67 FR 60744

Number of Respondents: 23

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	276	276
Annual IC Time Burden (Hours)	46	46
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Template		11/25/2024
Website Announcement		11/25/2024

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

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