ATSDR "Don't Mess with Mercury" Webinar Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0047 can be found here:

Documents and Forms

Document Name Document Type
ATSDR "Don't Mess with Mercury" Webinar Survey Form
Don't Mess with Mercury Webinar Survey Attachment C - DMWM Webinar Survey (on-line).docx Form
Attachment A Email Invitation for DMWM Webinar Survey.docx Email Invitation IC Document
0923-0047 GenIC Request Form DMWM Webinar Survey.pdf Request for Approval IC Document

Information Collection (IC) Details

IC Title:	ATSDR "Don't Mess with Mercury" Webinar Survey	Agency IC Tracking Number:	15BEE

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	none	Don't Mess with Mercury Webinar Survey	Attachment C - DMWM Webinar Survey (on-line).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Email Invitation	Attachment A Email Invitation for DMWM Webinar Survey.docx	08/19/2015
Request for Approval	0923-0047 GenIC Request Form DMWM Webinar Survey.pdf	08/19/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.