CSB Accidental Release Form

Accidental Release Reporting

Documents and Forms

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

Information Collection (IC) Details

IC Title:	CSB Accidental Release Form	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:

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 %

	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

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.