Water Efficiency Collection - State/Local Governments

EPA's WaterSense Program (Renewal)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2040-0272 can be found here:

Documents and Forms

Document Name Document Type
Form 6100-17 Water Efficiency Collection - State/Local Governments Form and Instruction
6100-17 Awards Application Promotional Partner Attachment 17 awards_promo.pdf epa.gov/watersense/docs/awards_promo508.pdf Form and Instruction
6100-09 Annual Reporting Form Promotional Attachment 10 Promo partner annual data_2009_fillable.pdf epa.gov/watersense/docs/annualdata_promo508.pdf Form and Instruction
6100-06 Partnership Agreement Promotional Partner Attachment 1 promo PA.pdf epa.gov/watersense/docs/partnership_promopartners508.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Water Efficiency Collection - State/Local Governments	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	6100-17	Awards Application Promotional Partner	Attachment 17 awards_promo.pdf	http://epa.gov/watersense/docs/awards_promo508.pdf	Yes	Yes	Fillable Printable
Form and Instruction	6100-09	Annual Reporting Form Promotional	Attachment 10 Promo partner annual data_2009_fillable.pdf	http://epa.gov/watersense/docs/annualdata_promo508.pdf	Yes	Yes	Fillable Printable
Form and Instruction	6100-06	Partnership Agreement Promotional Partner	Attachment 1 promo PA.pdf	http://epa.gov/watersense/docs/partnership_promopartners508.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: 357	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	357	143	0	214
Annual IC Time Burden (Hours)	2,877	0	-483	3,360
Annual IC Cost Burden (Dollars)	4,110	1,993	0	2,117

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.