Information Collection

NEARS Data Recording Form

IC 221095 under ICR 202601-0920-006 · OMB 0920-0980.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NEARS Data Recording Form	Form and Instruction
Data Recording Form NEARS Data Recording Form	Form and Instruction
Data Recording Form Att6 NEARS Environmental Assessment Recording Form 11-25_final.docx	Form and Instruction
Data Recording Form Att6 NEARS Environmental Assessment Recording Form 11-25_final.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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 and Instruction	n/a				Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 46

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,104	796	308
Annual IC Time Burden (Hours)	460	306	154
Annual IC Cost Burden (Dollars)	0	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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