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Technical Assist Details (screenshots)

ICR 202610-0923-001 · OMB 0923-0057 · Object 173998600.

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Document Metadata

Record metadata
application/pdf
Technical Assist Details (screenshots)
Crum, Kendall (ATSDR/OAD/OCDAPS)
Acrobat PDFMaker 23 for Word
2026-06-08
2023-06-12
complete

Extracted Text

ATSDR Technical Assistance TA (ARMSS Screenshots)
X

Create Activity
Activity Type
Technical Ass istance (TA)

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Requested Source Details (Opt ional}

Requested Source
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Request Description

Oo not e>Jter any Pl

Coop Program @

0 Yes
® No

Source POC (O ptional}

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flo not e>Jter any P I m u '19
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Jurisdiction
ATSOR

V

Choose Safe Places for Early Ca re and Education @

0 Yes
® No
Activity Name

Section
V

V

Planned Sta rt Date:

2023-05-02

Current POC

Team/ Reg ion

V

Notes (OptionaI}

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-

Form Approved
OMB No. 0923-0057
Exp. Date 09/30/2023
ATSDR estimates the average public reporting burden for this collection of information as 4 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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Tec hnical Assist Detailso

Actual Stu tOatt
2022-06-.22

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2022'06·22

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RHpon1t Summ.ary

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Approval Information (for ATS DR Use Only) o
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TA Approved for lulnse

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