Information Collection

CSB Accidental Release Form

IC 241475 under ICR 202406-3301-003 · OMB 3301-0001.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OMB No. 3301-0001 CSB Accidental Release Form	Form and Instruction
OMB No. 3301-0001 CSB Accidental Release Reporting Form and Instructions EXHIBIT 4 ARRR FORM 2024.05.14.docx www.csb.gov/news/incident-report-rule-form-/	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 40 CFR 1604

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	OMB No. 3301-0001	CSB Accidental Release Reporting Form and Instructions	EXHIBIT 4 ARRR FORM 2024.05.14.docx	https://www.csb.gov/news/incident-report-rule-form-/	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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	100	-101	201
Annual IC Time Burden (Hours)	25	-25	50
Annual IC Cost Burden (Dollars)	925	-935	1,860

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.