Data Collection for Poison Control Centers

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

Documents and Forms

Document Name Document Type
Data Collection for Poison Control Centers Form
Data Collection for Poison Control Centers AttE_DataCollForm_ScreenShots.pdf Form

Information Collection (IC) Details

IC Title:	Data Collection for Poison Control Centers	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 Poison Control Centers	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: 80	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	80	80
Annual IC Time Burden (Hours)	40	40
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.