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Federal forms, ICRs, and supporting documents

Information Collection

Lower Duwamish Waterway Superfund Site ICIAP "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms

IC 268119 under ICR 202404-2030-001 · OMB 2030-0051.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 6700-021
Lower Duwamish Waterway Superfund Site ICIAP "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms		 Form
6700-021 CHA Behavior Survey
CHA_BehaviorSurvey.pdf 		Form
6700-021 CHA Behavior Survey
CHA_BehaviorSurvey.pdf 		Form
6700-022 Pre-Assessment of CHAs-in-Training
PREcurric_Final.pdf 		Form
6700-022 Pre-Assessment of CHAs-in-Training
PREcurric_Final.pdf 		Form
6700-023 Post-Assessment of CHAs-in-Training
POSTcurric_FINAL.pdf 		Form
6700-023 Post-Assessment of CHAs-in-Training
POSTcurric_FINAL.pdf 		Form
6700-026 Fishers Workshop Background Survey
FishersWG_BackgroundSurvey.pdf 		Form
6700-026 Fishers Workshop Background Survey
FishersWG_BackgroundSurvey.pdf 		Form
6700-018 Fishers Workshop PRE-Survey
FishersWG_PreSurvey.pdf 		Form
6700-018 Fishers Workshop PRE-Survey
FishersWG_PreSurvey.pdf 		Form
6700-019 Fishers Workshop POST-Survey
FishersWG_PostSurvey.pdf 		Form
6700-019 Fishers Workshop POST-Survey
FishersWG_PostSurvey.pdf 		Form
6700-020 Fishers Workshop Pledges
FishersWG_Pledges.pdf 		Form
6700-020 Fishers Workshop Pledges
FishersWG_Pledges.pdf 		Form
6700-017 Moms and Caregivers Background Survey
MomsWG_BackgroundSurvey.pdf 		Form
6700-017 Moms and Caregivers Background Survey
MomsWG_BackgroundSurvey.pdf 		Form
6700-016 Moms and Caregivers Mini Quiz
MomsWG_MiniQuiz.pdf 		Form
6700-016 Moms and Caregivers Mini Quiz
MomsWG_MiniQuiz.pdf 		Form
6700-015 Moms and Caregivers Pledges
MomsWG_Pledges.pdf 		Form
6700-015 Moms and Caregivers Pledges
MomsWG_Pledges.pdf 		Form
6700-014 Moms and Caregivers Self-Assessment
MomsWG_SelfAssessment.pdf 		Form
6700-014 Moms and Caregivers Self-Assessment
MomsWG_SelfAssessment.pdf 		Form
6700-013 Outreach Event Survey
OutreachEventSurvey.pdf 		Form
6700-013 Outreach Event Survey
OutreachEventSurvey.pdf 		Form
Justification_R10_Lower Duwamish Waterway ICIAP Program.docx
Justification		IC Document
Justification_R10_Lower Duwamish Waterway ICIAP Program.docx
Justification		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 6700-021 CHA Behavior Survey CHA_BehaviorSurvey.pdf Yes Yes Fillable Printable
Form 6700-022 Pre-Assessment of CHAs-in-Training PREcurric_Final.pdf Yes Yes Fillable Printable
Form 6700-023 Post-Assessment of CHAs-in-Training POSTcurric_FINAL.pdf Yes Yes Fillable Printable
Form 6700-026 Fishers Workshop Background Survey FishersWG_BackgroundSurvey.pdf Yes Yes Fillable Printable
Form 6700-018 Fishers Workshop PRE-Survey FishersWG_PreSurvey.pdf Yes Yes Fillable Printable
Form 6700-019 Fishers Workshop POST-Survey FishersWG_PostSurvey.pdf Yes Yes Fillable Printable
Form 6700-020 Fishers Workshop Pledges FishersWG_Pledges.pdf Yes Yes Fillable Printable
Form 6700-017 Moms and Caregivers Background Survey MomsWG_BackgroundSurvey.pdf Yes Yes Fillable Printable
Form 6700-016 Moms and Caregivers Mini Quiz MomsWG_MiniQuiz.pdf Yes Yes Fillable Printable
Form 6700-015 Moms and Caregivers Pledges MomsWG_Pledges.pdf Yes Yes Fillable Printable
Form 6700-014 Moms and Caregivers Self-Assessment MomsWG_SelfAssessment.pdf Yes Yes Fillable Printable
Form 6700-013 Outreach Event Survey OutreachEventSurvey.pdf Yes Yes Fillable Printable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 675 0 675 0 0 0
Annual IC Time Burden (Hours) 323 0 323 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Justification Justification_R10_Lower Duwamish Waterway ICIAP Program.docx 05/30/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.