Information Collection

State Primacy Agencies (including Navajo Nation)

IC 243298 under ICR 202308-2040-003 · OMB 2040-0302.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 6100-01 State Primacy Agencies (including Navajo Nation)	Form and Instruction
6100-01 2020 Drinking Water Infrastructure Needs Survey and Asse 6100-01 (Forms & Instructions).docx dwneeds.epa.gov	Form and Instruction
6100-01 2020 Drinking Water Infrastructure Needs Survey and Asse 6100-01 (Forms & Instructions).docx dwneeds.epa.gov	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	6100-01	2020 Drinking Water Infrastructure Needs Survey and Assessment	6100-01 (Forms & Instructions).docx	dwneeds.epa.gov	Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 57

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	Previously Approved
Annual Number of Responses for this IC	19	19
Annual IC Time Burden (Hours)	7,525	7,525
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.