EJScreen Useful Survey

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2010-0042 can be found here:

Documents and Forms

Document Name Document Type
2434ss58 EJScreen Useful Survey.docx Other-Other
2434ss58 EJScreen Useful Justification.docx 2434ss58 EJScreen Useful Justification IC Document

Information Collection (IC) Details

IC Title:	EJScreen Useful Survey	Agency IC Tracking Number:	2434.58

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
Other-Other			2434ss58 EJScreen Useful Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Environmental Monitoring and Forecasting

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	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	2,000	2,000
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
2434ss58 EJScreen Useful Justification	2434ss58 EJScreen Useful Justification.docx	10/18/2016

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