Site Impact Assessment Form

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Attachment 4c. ATSDR Site Impact Assessment (SIA) Form (ARMS Screenshots)

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Completed

Form Approved
OMB No. 0923-0057
Exp. Date 09/30/2023
ATSDR estimates the average public reporting burden for this collection of information as 7 minutes response, including the time for reviewing instructions, searching existing data/information sources,
gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a
collection of information unless it displays a current valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS H21-8, Atlanta, Georgia 30333; ATTN: PRA (0923-0057).

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