Data Collection for Other State and Local Governments

State Surveillance under the National Toxic Substance Incidents Program (NTSIP)

Documents and Forms

Document Name Document Type
Data Collection for Other State and Local Governments Form
Data Collection for Other State and Local Governments AttE_DataCollForm_ScreenShots.pdf Form

Information Collection (IC) Details

IC Title:	Data Collection for Other State and Local Governments	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	none	Data Collection for Other State and Local Governments	AttE_DataCollForm_ScreenShots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	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
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	30	30
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.