OMB
.report
Search
Lower Duwamish Waterway Superfund Site ICIAP "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (Renewal)
OMB: 2030-0051
IC ID: 268119
OMB.report
EPA/OMS
OMB 2030-0051
ICR 202404-2030-001
IC 268119
( )
Documents and Forms
Document Name
Document Type
Form 6700-021
Lower Duwamish Waterway Superfund Site ICIAP "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms
Form
6700-021 CHA Behavior Survey
CHA_BehaviorSurvey.pdf
Form
6700-021 CHA Behavior Survey
CHA_BehaviorSurvey.pdf
Form
6700-022 Pre-Assessment of CHAs-in-Training
PREcurric_Final.pdf
Form
6700-022 Pre-Assessment of CHAs-in-Training
PREcurric_Final.pdf
Form
6700-023 Post-Assessment of CHAs-in-Training
POSTcurric_FINAL.pdf
Form
6700-023 Post-Assessment of CHAs-in-Training
POSTcurric_FINAL.pdf
Form
6700-026 Fishers Workshop Background Survey
FishersWG_BackgroundSurvey.pdf
Form
6700-026 Fishers Workshop Background Survey
FishersWG_BackgroundSurvey.pdf
Form
6700-018 Fishers Workshop PRE-Survey
FishersWG_PreSurvey.pdf
Form
6700-018 Fishers Workshop PRE-Survey
FishersWG_PreSurvey.pdf
Form
6700-019 Fishers Workshop POST-Survey
FishersWG_PostSurvey.pdf
Form
6700-019 Fishers Workshop POST-Survey
FishersWG_PostSurvey.pdf
Form
6700-020 Fishers Workshop Pledges
FishersWG_Pledges.pdf
Form
6700-020 Fishers Workshop Pledges
FishersWG_Pledges.pdf
Form
6700-017 Moms and Caregivers Background Survey
MomsWG_BackgroundSurvey.pdf
Form
6700-017 Moms and Caregivers Background Survey
MomsWG_BackgroundSurvey.pdf
Form
6700-016 Moms and Caregivers Mini Quiz
MomsWG_MiniQuiz.pdf
Form
6700-016 Moms and Caregivers Mini Quiz
MomsWG_MiniQuiz.pdf
Form
6700-015 Moms and Caregivers Pledges
MomsWG_Pledges.pdf
Form
6700-015 Moms and Caregivers Pledges
MomsWG_Pledges.pdf
Form
6700-014 Moms and Caregivers Self-Assessment
MomsWG_SelfAssessment.pdf
Form
6700-014 Moms and Caregivers Self-Assessment
MomsWG_SelfAssessment.pdf
Form
6700-013 Outreach Event Survey
OutreachEventSurvey.pdf
Form
6700-013 Outreach Event Survey
OutreachEventSurvey.pdf
Form
Justification_R10_Lower Duwamish Waterway ICIAP Program.docx
Justification
IC Document
Justification_R10_Lower Duwamish Waterway ICIAP Program.docx
Justification
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Lower Duwamish Waterway Superfund Site ICIAP "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms
Agency IC Tracking Number:
2434.266
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
6700-021
CHA Behavior Survey
CHA_BehaviorSurvey.pdf
Yes
Yes
Fillable Printable
Form
6700-022
Pre-Assessment of CHAs-in-Training
PREcurric_Final.pdf
Yes
Yes
Fillable Printable
Form
6700-023
Post-Assessment of CHAs-in-Training
POSTcurric_FINAL.pdf
Yes
Yes
Fillable Printable
Form
6700-026
Fishers Workshop Background Survey
FishersWG_BackgroundSurvey.pdf
Yes
Yes
Fillable Printable
Form
6700-018
Fishers Workshop PRE-Survey
FishersWG_PreSurvey.pdf
Yes
Yes
Fillable Printable
Form
6700-019
Fishers Workshop POST-Survey
FishersWG_PostSurvey.pdf
Yes
Yes
Fillable Printable
Form
6700-020
Fishers Workshop Pledges
FishersWG_Pledges.pdf
Yes
Yes
Fillable Printable
Form
6700-017
Moms and Caregivers Background Survey
MomsWG_BackgroundSurvey.pdf
Yes
Yes
Fillable Printable
Form
6700-016
Moms and Caregivers Mini Quiz
MomsWG_MiniQuiz.pdf
Yes
Yes
Fillable Printable
Form
6700-015
Moms and Caregivers Pledges
MomsWG_Pledges.pdf
Yes
Yes
Fillable Printable
Form
6700-014
Moms and Caregivers Self-Assessment
MomsWG_SelfAssessment.pdf
Yes
Yes
Fillable Printable
Form
6700-013
Outreach Event Survey
OutreachEventSurvey.pdf
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Environmental Management
Subfunction:
Environmental Remediation
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
675
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
675
0
675
0
0
0
Annual IC Time Burden (Hours)
323
0
323
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Justification
Justification_R10_Lower Duwamish Waterway ICIAP Program.docx
05/30/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.