ATSDR Site Impact Assessment Form

APPLETREE Performance Measures

OMB: 0923-0057

IC ID: 226336

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Document Name
Document Type
Form and Instruction
Other-Word document to display instr
Form and Instruction
Information Collection (IC) Details

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ATSDR Site Impact Assessment Form
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Site Impact Assessment Form Att4c SIA Form_Screenshots 20200325.docx Yes Yes Fillable Fileable
Other-Word document to display instrument content Att4c SIA Form_Word 20200325.docx No   Paper Only

Health Consumer Health and Safety

 

28 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 112 0 -38 0 0 150
Annual IC Time Burden (Hours) 13 0 -5 0 0 18
Annual IC Cost Burden (Dollars) 487 0 487 0 0 0

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

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