Optional Questionnaire

Tier 1 Screening of Certain Chemicals Under the Endocrine Disruptor Screening Program (EDSP)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2070-0176 can be found here:

Documents and Forms

Document Name Document Type
Form 6300-05-Q Optional Questionnaire Form
6300-05-Q Optional Questionnaire Level of Effort for Recipients of 2249.01_Amendment-F2_Optional-Qs-2009-09-18.pdf Form

Information Collection (IC) Details

IC Title:	Optional Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	6300-05-Q	Optional Questionnaire Level of Effort for Recipients of Tier 1 Screening Orders	2249.01_Amendment-F2_Optional-Qs-2009-09-18.pdf		Yes	Yes	Fillable Printable

Line of Business: Environmental Management

Subfunction: Environmental Monitoring and Forecasting

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 384	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	384	384
Annual IC Time Burden (Hours)	243	243
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.