Open Burn Pit Registry Airborne Hazard Web-Accessible Self-Assessment/

Open Burn Pit Registry Web-accessible Self-Assessment/Questionnaire

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0800 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 10-10066 Open Burn Pit Registry Airborne Hazard Web-Accessible Self-Assessment/ Form
VA Form 10-10066 Open Pit Burn Registry Web-accessible Self-Assessment/Qu Form 10-10066_Open Burn Pit Self-Assessment 10-22-13.pdf To be determined Form

Information Collection (IC) Details

IC Title:	Open Burn Pit Registry Airborne Hazard Web-Accessible Self-Assessment/	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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	VA Form 10-10066	Open Pit Burn Registry Web-accessible Self-Assessment/Questionnaire	Form 10-10066_Open Burn Pit Self-Assessment 10-22-13.pdf	To be determined	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	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	0	0	0	0	0	0
Annual IC Time Burden (Hours)	0	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	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.