Community Members - ACAS Hard Copy

ATSDR Communication Activities Survey (ACAS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0055 can be found here:

Documents and Forms

Document Name Document Type
Community Members - ACAS Hard Copy Form and Instruction
ATSDR Community Activities Survey - Hardcopy AttF1 Hardcopy ACAS 06122017 clean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Community Members - ACAS Hard Copy	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 and Instruction	NA	ATSDR Community Activities Survey - Hardcopy	AttF1 Hardcopy ACAS 06122017 clean.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: Records of Persons Exposed or Potentially Exposed to Hazardous or Toxic Substances	FR Citation: 53 FR 30702

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	25	25
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.