Information Collection

Environmental Information and Documentation Checklist

IC 189032 under ICR 202501-0915-001 · OMB 0915-0324.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Environmental Information and Documentation Checklist	Form
Form 1 FORM - environmental_checklist - 051625 (clean)_final.docx Environmental Information and Documentation Checklist	Form
Form 1_R FORM - environmental_checklist - 051625 (redline)_final.docx Environmental Information and Documentation Checklist	Form
1 Environmental_checklist FORM - environmental_checklist - (0324) - Expiration April 2028.docx	Form
1 FORM - environmental_checklist - 051625 (clean)_final.do FORM - environmental_checklist - 051625 (clean)_final.docx	Form
1_R FORM - environmental_checklist - 051625 (redline)_final. FORM - environmental_checklist - 051625 (redline)_final.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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	1				Yes	Yes	Fillable Fileable
Form	1_R				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	1,500	1,500
Annual IC Cost Burden (Dollars)	0	0

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.

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