CSPECE Qualitative Narrative Form

[ATSDR] APPLETREE Performance Measures

Documents and Forms

Document Name Document Type
CSPECE Qualitative Narrative Form Form and Instruction
CSPECE Qualitative Narrative Reporting Supplement Att4f CSPECE Qualitative Narrative Form 08312023.docx Form and Instruction
CSPECE Qualitative Narrative Reporting Supplement Att4f CSPECE Qualitative Narrative Form 08312023.docx Form and Instruction

Information Collection (IC) Details

IC Title:	CSPECE Qualitative Narrative Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	CSPECE Qualitative Narrative Reporting Supplement	Att4f CSPECE Qualitative Narrative Form 08312023.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	30	2	28
Annual IC Time Burden (Hours)	30	2	28
Annual IC Cost Burden (Dollars)	0	-1,044	1,044

Documents for IC

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.