Application for Nebert Award - State, Local

DOUG D. NEBERT NSDI CHAMPION OF THE YEAR AWARD

Documents and Forms

Document Name Document Type
1028-New NebertAwardNomination instrument 2022-04-25.docx Instruction
1028-New NebertAwardNomination instrument 2022-04-25.docx Instruction

Information Collection (IC) Details

IC Title:	Application for Nebert Award - State, Local	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			1028-New NebertAwardNomination instrument 2022-04-25.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	5	5
Annual IC Time Burden (Hours)	50	50
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.