Information Collection

CSB Accidental Release Form

IC 241475 under ICR 202405-3301-001 · OMB 3301-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3301-0001 can be found here:

Documents and Forms

Document Name Document Type
Form OMB No. 3301-0001 CSB Accidental Release Form Form
Accidental Release Reporting form instructions_revised_2021.02.19_(2).pdf www.csb.gov/assets/1/6/instructions_revised_2021.02.19_(2).pdf Instruction
OMB No. 3301-0001 CSB Accidental Release Form Accidental Release Reporting formrevised_2021.02.19_fillable.pdf www.csb.gov/assets/1/6/formrevised_2021.02.19_fillable.pdf Form
OMB No. 3301-0001 CSB Accidental Release Reporting Form EXHIBIT 4 ARRR FORM 2024.05.14.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CSB Accidental Release Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 40 CFR 1604

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	OMB No. 3301-0001	CSB Accidental Release Form	Accidental Release Reporting formrevised_2021.02.19_fillable.pdf	https://www.csb.gov/assets/1/6/formrevised_2021.02.19_fillable.pdf	Yes	Yes	Fillable Printable
Instruction			Accidental Release Reporting form instructions_revised_2021.02.19_(2).pdf	https://www.csb.gov/assets/1/6/instructions_revised_2021.02.19_(2).pdf	Yes	No	Printable Only
Form and Instruction	OMB No. 3301-0001	CSB Accidental Release Reporting Form	EXHIBIT 4 ARRR FORM 2024.05.14.docx		Yes	Yes	Fillable Printable

Line of Business: Disaster Management

Subfunction: Disaster Monitoring and Prediction

Privacy Act System of Records
Title: Not applicable	FR Citation: 40 FR 1604

Number of Respondents: 100	Number of Respondents for Small Entity: 100

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	100	-101	201
Annual IC Time Burden (Hours)	18	-32	50
Annual IC Cost Burden (Dollars)	925	-935	1,860

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.