Information Collection

Customer Satisfaction Surveys for feedback on the EJ TCTACs

IC 268115 under ICR 202404-2030-001 · OMB 2030-0051.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5800-091 Customer Satisfaction Surveys for feedback on the EJ TCTACs	Form
5800-091 EJ TCTAC Intake Form Center A Center A_Northwest Environmental Justice Center.docx	Form
5800-091 EJ TCTAC Intake Form Center A Center A_Northwest Environmental Justice Center.docx	Form
5800-092 EJ TCTAC Intake Form Center B Center B_EAGLE.docx	Form
5800-092 EJ TCTAC Intake Form Center B Center B_EAGLE.docx	Form
5800-093 EJ TCTAC Intake Form Center C Center C_NIHB.docx	Form
5800-093 EJ TCTAC Intake Form Center C Center C_NIHB.docx	Form
EJ TCTACs Survey IC Justification.docx Justification	IC Document
EJ TCTACs Survey IC Justification.docx Justification	IC Document

IC Title:

Agency IC Tracking Number:

2434.264

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	5800-091	EJ TCTAC Intake Form Center A	Center A_Northwest Environmental Justice Center.docx	Yes	Yes	Fillable Fileable
Form	5800-092	EJ TCTAC Intake Form Center B	Center B_EAGLE.docx	Yes	Yes	Fillable Fileable
Form	5800-093	EJ TCTAC Intake Form Center C	Center C_NIHB.docx	Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Environmental Monitoring and Forecasting

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,500

Number of Respondents for Small Entity: 1,500

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	375	375
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification	EJ TCTACs Survey IC Justification.docx	05/30/2024

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