Information Collection

Application for Preauthorization of a CERCLA Response Action

IC 23885 under ICR 202605-2050-001 · OMB 2050-0106.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2075-3 Application for Preauthorization of a CERCLA Response Action Application for Preauthorization of a CERCLA Response Action	Form
Form 2075-4 Claim for CERCLA Response Action Application for Preauthorization of a CERCLA Response Action	Form
2075-3 Application for Preauthorization of a CERCLA Response Ac EPA Form 2075-3_Application for Preauthorization of a CERCLA Response Action.docx	Form
2075-4 Claim for CERCLA Response Action EPA Form 2075-4_Claim for CERCLA Response Action.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: 40 CFR 307

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	2075-3				Yes	Yes	Fillable Fileable
Form	2075-4				Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Environmental Remediation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	2	-15	17
Annual IC Time Burden (Hours)	161	-1,807	1,968
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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