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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
LISS Partnership DEI/EJ Readiness Survey
New
120
30
0
Form
6700-025
LISS Partnership DEI/EJ Survey
19th Annual EPA Drinking Water Workshop Attendee Survey of Satisfaction
New
2104
246
0
Form
6000-017
2022 EPA DW Workshop Evaluation Questions-In-person attendees
Form
6000-018
2022 EPA DW Workshop Evaluation Questions-virtual attendees
2024 Northeast West Plains PFAS Drinking Water Sampling Event
New
300
100
0
Form and Instruction
6700-024
NE West Plains PFAS Drinking Water Sampling Interest Questions
20th Annual EPA Drinking Water Workshop Attendee Survey of Satisfaction
New
230
15
0
Form
6000-027
Evaluation Survey: EPA Annual Drinking Water Workshop: Small System Challenges and Solutions
Annual EPA Drinking Water Workshop Breakout Focus Groups Facilitation Questions and Attendee Survey of Satisfaction
New
2870
284
0
Form
5900-524
Evaluation Survey: 18th Annual EPA Drinking Water Workshop: Small System Challenges and Solutions
Form and Instruction
5900-525
Survey/Evaluation Questions for DW Workshop
Brownfields Minimizing Displacement Technical Assistance Participant Satisfaction Survey
New
60
10
0
Form
6200-030
Minimizing Displacement Resulting from Brownfields Assessment, Cleanup and Reuse
CORE Survey Questions (Students, Adults, and Community)
New
380
95
0
Form
6100-076
Core Survey
Campus RainWorks Challenge Survey
New
143
72
0
Form and Instruction
5800-051
Campus RainWorks Survey
Central Data Exchange (CDX) Customer Satisfaction Survey
New
6990
233
0
Form and Instruction
5800-018
CDX Customer Satisfaction with Program Services
Central Data Exchange (CDX) Help Desk Survey
New
4368
364
0
Form and Instruction
5800-019
CDX Help Desk Survey
Channelview ISD Teacher discussion to identify project priorities and needs for the 2024-25 school year
New
15
15
0
Instruction
Clean Air Markets Division Beta Testing Survey
New
35
5
0
Form
5800-058
CAMD’s Clean Air Markets Program Data Beta Testing Survey
Climate & Sustainability Event Survey for the GPCOG EJG2G Community Resilience Program
New
600
50
0
Form
6700-031
Climate & Sustainability Event Survey
Climate and Economic Justice Screening Tool (CJEST) Site Satisfaction and Data Set Survey
New
1000
250
0
Form
N/A
CEJST Consolidated Survey
Community Change Technical Assistance
New
250
17
0
Form
5800-089
Environmental and Climate Justice Community Change Technical Assistance Request Form
Crisfield Resilience Academy
New
740
163
0
Form
6000-023
CRISFIELD RESILIENCE ACADEMY: PRE-SURVEY QUESTIONS
Form
6000-024
CRISFIELD RESILIENCE ACADEMY: POST-SURVEY QUESTIONS
Form
6000-025
Crisfield Resilience Academy Session Evaluation
Form and Instruction
6000-026
Crisfield 6-month Post-Academy Interview Protocol
Customer Satisfaction Survey for EPA's Adaptation Resource Center (ARC-X)
New
3000
375
0
Form
5800-086
ARC-X User Satisfaction Survey
Customer Satisfaction Survey for Healthier School Environments Workshops
New
1250
104
0
Form
5800-040
HEALTHIER SCHOOL ENVIRONMENTS WORKSHOP CUSTOMER SATISFACTION SURVEY
Customer Satisfaction Survey for Lead Awareness in Indian Country: Keeping our Children Healthy! Curriculum (Lead Awareness Curriculum) Train-the-Trainer Sessions
New
6724
19
0
Other-Survey Series
Customer Satisfaction Survey for State Government Officials that Participated in the Office of Research and Development's FY2019-2022 Strategic Research Planning and Implementation Process
New
51
8
0
Form
5800-041
ORD State Engagement Feedback Survey
Customer Satisfaction Survey for the America Recycles Events
New
537
73
0
Form
6200-021
America Recycles 2020 Event Survey & Pledge Signer Input
Customer Satisfaction Surveys for Feedback on Technical Assistance to Brownfield Communities
New
950
32
0
Form
6200-031
Technical Assistance to Brownfield Communities – Evaluation Questions
Customer Satisfaction Surveys for feedback on the Community, Equity and Resiliency (CER) Regional Roadshow Events
New
2000
500
0
Form
5800-090
Community, Equity and Resiliency (CER) Regional Roadshow Events Survey
Customer Satisfaction Surveys for intake of the EJ TCTACs
New
1500
375
0
Form
5800-091
EJ TCTAC Intake Form Center A
Form
5800-092
EJ TCTAC Intake Form Center B
Form
5800-093
EJ TCTAC Intake Form Center C
Customer Satisfaction Surveys for the Pesticide Safety Education Funds Management Program
New
56
5
0
Form
9600-056
Customer Satisfaction Survey: Pesticide Safety Education Funds Management Program
Cuyahoga County Board of Health Feedback Activity during Health Impact Assessment Training Sessions
New
180
30
0
Form and Instruction
HIA Training Feedback Storytelling Activity
6700-082
Instruction
DSIMB – ICIS Customer Support Post Training Survey
New
2000
133
0
Form
5800-081
DSIMB Standard Post-Training Questions
Data Completeness Survey for NPDES Significant Noncompliance National Compliance Initiative's Integrated Compliance Information System
New
558
46
0
Form and Instruction
5800-079
SNC NCI ICIS-NPDES Data Completeness Survey
ECHO Post Training Survey Questions
New
2300
154
0
Form
5800-037
ECHO Post Training Survey Questions
ECHO Tools Survey
New
700
47
0
Form
5800-0085
ECHO Tool Survey Questions
EJScreen 2022 Impact Survey
New
5000
833
0
Form
5800-016
EJScreen 2022 Impact Survey
EPA Docket Center Customer Satisfaction Survey
New
270
22
0
Form
5800-003
Customer Service Survey
EPA OECA Career Fair Outreach and Information Group Survey
New
400
100
0
Form
5800-071
EPA OECA Career Fair Outreach and Information Group Survey
EPA OECA Career Fair and Career Fair Website Survey
New
1200
100
0
Form and Instruction
5800-072
EPA OECA Career Fair and Career Fair Website Survey
EPA Water Quality Standards Academy Student Course Evaluation
New
225
37
0
Form
5800-047
Water Quality Standards Academy Evaluation Form
EnviroAtlas Survey
New
200
50
0
Form
5800-007
EnviroAtlas Survey
Environmental Protection Agency Federal Technology Transfer Act Questionnaire
New
321
80
0
Form
5800-060
Federal Technology Transfer Act Questionaire
Equitable Resilience Builder Tool Feedback Survey
New
813
203
0
Form
6000-030
Equitable Resilience Builder Tool Feedback Survey
Equitable Resilience Technical Assistance
New
100
17
0
Form
5800-088
Equitable Resilience Technical Assistance for Community Change Grants - Request Form
Evaluating Diesel Emissions Reduction Act (DERA) Program Customer Satisfaction in EPA Regions 9 and 10
New
90
900
0
Form
5800-0012
Evaluating Diesel Emissions Reduction Act (DERA) Program Customer Satisfaction in EPA Regions 9 and 10
Evaluating the Pilot Los Angeles Public Library Sensor Loan Program: Patron Air Sensor Use Component
New
120
1800
0
Form
5800-013
Los Angeles Public Library Patron Air Sensor Loan Survey
Evaluation Forms for the National Tanks Conference and Expo
New
260
7
0
Form
5800-043
Individual Session Evaluation Form 27th National Tanks Conference and Expo
Form
5800-044
Conference Evaluation Form 27th National Tanks Conference and Expo
Evaluation of Environmental Collaboration and Conflict Resolution (ECCR) Services and Training at EPA
New
1549
174
0
Form
5800-020
Agreement Seeking Case Lead Administrative Proceeding Evaluation Survey
Form
5800-022
Agreement Seeking Case Lead Agency Decision Evaluation Survey
Form
5800-023
Agreement Seeking Case Lead Judicial Proceeding Evaluation Survey
Form
5800-024
Agreement Seeking Participant Administrative Proceeding Evaluation Survey
Form
5800-025
Agreement Seeking Participant Agency Decision Evaluation Survey
Form
5800-026
Agreement Seeking Participant Judicial Proceeding Evaluation Survey
Form
5800-027
Facilitated Dialogue Participant Questionnaire
Form
5800-028
Follow-up Effects Survey Case Lead Administrative Proceeding
Form
5800-029
Follow-up Effects Survey Case Lead Agency Decision
Form
5800-030
Follow-up Effects Survey Case Lead Judicial Proceeding
Form
5800-031
Follow-up Effects Survey Participant Administrative Proceeding
Form
5800-032
Follow-up Effects Survey Participant Agency Decision
Form
5800-033
Follow-up Effects Survey Participant Judicial Proceeding
Form
5800-034
Long Term Group Facilitation Participant Questionnaire
Form
5800-035
Meeting Facilitation Questionnaire
Form
5800-036
Training Evaluation Survey
Feedback Survey: NWEJC Launch Event
New
135
11
0
Form
5800-095
Feedback Survey: Northwest Environmental Justice Center Launch Event
Feedback survey for participants of Healthy Homes and ECO Neighborhoods' learning experiences
New
1200
300
0
Form
6700-034
Healthy Homes and ECO Neighborhoods Survey
Form
6700-035
Healthy Homes Assessment and Energy Audit Feedback
Focus Group on Better Methods of Communicating Pesticide Label Information in Spanish
New
60
90
0
Other-Focus Group Script
Other-Activity Overview
Focus groups for feedback on the EJ TCTACs
New
800
2400
0
Instruction
Great Lakes AOC Project Area Community Use and Benefits Site User Satisfaction Survey
New
240
20
0
Form
5800-049
Site User Satisfaction Survey
Greening Urban Neighborhoods from the Ground Up
New
800
67
0
Form
6700-010
Far Eastside Survey
Groundwork USA Nonprofit Technical Assistance Grant Satisfaction Surveys
New
375
62
0
Form
6200-033
Groundwork USA Nonprofit Technical Assistance Grant Customer Satisfaction Survey
Guest Speaker Survey
New
140
1
0
Form
5800-039
Guest Speaker Survey
Gulf of Mexico Division Funding Opportunities
New
750
188
0
Form
6700-912
Gulf of Mexico Division Funding Opportunities
Helpdesk Customer Satisfaction Survey for the Integrated Compliance Information System (ICIS) and the National Pollutant Discharge Elimination System (NPDES) eReporting Tools (NeT, NeTDMR)
New
2000
133
0
Form
5800-010
Helpdesk Customer Satisfaction Survey for the Integrated Compliance Information System (ICIS) and the National Pollutant Discharge Elimination System (NPDES) eReporting Tools (NeT, NeTDMR)
Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline Interview
New
20
20
0
Instruction
Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline Survey
New
156
20
0
Form
6700-027
Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline 1st Survey
Form
6700-028
Homeowner Perceptions, Barriers, and Intentions to Install a Living Shoreline 2nd Survey
Impact Analysis Questions for Communities in the Southeast New England Program Network (SNEP)
New
30
8
0
Form
6700-011
Impact Analysis Questions for Communities
Industrial Stormwater Sector-Specific Fact Sheets Meetings for the Multi-Sector Industrial Stormwater Permit (MSGP)
New
346
29
0
Form
5900-577
Webcasts for Potential Updates to the Fact Sheets Associated with the Environmental Protection Agency’s Multi-Sector General Permit FY 2022
Interview Questions for the Integrated Compliance Information System (ICIS) Concept of Operations Business Requirements
New
120
240
0
Instruction
LRRP Survey - Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO
New
37
6
0
Form
5800-076
Renovation, Repair and Painting Training Course Participant Survey
Land Revitalization Technical Assistance program (LRTA) Customer Satisfaction Survey
New
72
18
0
Form
6200-035
Land Revitalization Technical Assistance to Brownfields Communities (LRTA) – Evaluation Questions
Lower Duwamish Waterway Superfund Site Institutional Control Implementation Assurance Plan (ICIAP) "Fun to Catch, Toxic to Eat" Programmatic Evaluation Forms
New
675
323
0
Form
6700-013
Public Health Seattle & King County EPA Outreach Event Survey
Form
6700-014
Moms and Caregivers Self-Assessment (Multiple Languages)
Form
6700-015
Moms and Caregivers Pledges (Multiple Languages)
Form
6700-016
Moms and Caregivers Mini Quiz (Multiple Languages)
Form
6700-017
Moms and Caregivers Background Survey (Multiple Languages)
Form
6700-018
Fishers Workshop PRE-Survey (Multiple Languages)
Form
6700-019
Fishers Workshop POST-Survey (Multiple Languages)
Form
6700-020
Fishers Workshop Pledges (Multiple languages)
Form
6700-021
CHA Behavior Survey
Form
6700-022
Pre-Assessment of CHAs-in-Training
Form
6700-023
Post-Assessment of CHAs-in-Training
NAMs Training Survey
New
7500
400
0
Form
6000-019
NAMs Training: Registration / Pre-Training
Form
6000-020
NAMs Training: Feedback (Post-Training
OEJECR EJ Grantee Post-Orientation Feedback Survey
New
525
35
0
Form
5800-094
OEJECR EJ Grantee Post-Orientation Feedback Survey
ORD Digital Design Industry Feedback
New
20
10
0
Form
5800-061
Research Participant Agreement and Consent Notice
ORD Digital Design System Usability Evaluation Survey
New
120
10
0
Form
5800-062
Research Participant Agreement and Consent Notice
ORD Digital Design System Usability Evaluation Survey Follow-up
New
96
32
0
Form
5800-062
ORD Digital Design System Usability Evaluation Survey Follow up Survey Instruments
Office of Acquisition Solutions (OAS) Online FOIA Survey
New
75
5
0
Form
5800-064
Office of Acquisition Solutions (OAS) Online FOIA Survey
Office of Administrative Law Judges Alternative Dispute Resolution Process User Survey
New
10
1
0
Form
5800-017
User Survey
Office of Research & Development's EPA Tools & Resources Webinar Series and EPA Science Training Webinars - Attendee Satisfaction Survey
New
869
101
0
Form and Instruction
5800-020
EPA Tools & Resources Webinar Series and EPA Science Training Webinars Evaluation Form
Office of Research and Development Science Matters Newsletter Customer Satisfaction Survey
New
15200
1267
0
Form
5800-011
Science Matters Survey
Office of Research and Development/Office of Water (ORD/OW) Small Systems Webinar Series Attendee Survey of Satisfaction
New
2100
280
0
Form
5800-042
EPA's Small Drinking Water Systems Webinar Series Survey
Oʻahu Climate Champions Final Reflection
New
30
5
0
Form and Instruction
6700-030
Climate Champion Final Reflection
Oʻahu Climate Champions Monthly Reflections
New
84
21
0
Form and Instruction
6700-029
Climate Champion Monthly Reflection
Pipe Up Campaign Phase 3: Campaign Message Testing
New
24
36
0
Other-Focus Group Guide Intro Page
Instruction
Planning with Structured Decision Making/DASEES
New
100
8
0
Form
5800-059
Planning with Structured Decision Making/DASEES
Post-Training Survey - Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO)
New
30
8
0
Form
5800-074
Lead Awareness Curriculum Train-the-Trainer Survey
Post-webinar Survey Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO)
New
15
2
0
Form
5800-075
Understanding Lead Webinar Survey
Pre-Training Survey - Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO)
New
37
6
0
Form
5800-073
Community Lead Awareness Survey
Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations
New
250
219
0
Form and Instruction
6100-082
Discusion Guide - Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations
Form and Instruction
6100-081
Screener - Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations
Pretesting Outreach Materials for Fish Consumption Advisories to Reach Vulnerable Populations
New
250
219
0
Instruction
Instruction
Pretesting Outreach and Web Materials for Fish Consumption Advisories
New
44
44
0
Form and Instruction
5800-015
Final Screener
Form and Instruction
5800-14
Discussion Guide
Survey Soliciting Input for Vision 2032 Plan
New
400
100
0
Other-Survey Questions
Survey Tool Soliciting Input for Narragansett Bay Estuary Program's Diversity, Equity, Inclusion, and Justice Assessment
New
150
23
0
Instruction
Survey for Smart Growth Network Quarterly Discussions
New
25
13
0
Form
5800-087
Customer Service Questions for Smart Growth Network Quarterly Discussion
Survey for feedback on Spring 2022 Region 5 State and Tribal Wetland Meeting
New
14
1
0
Form
5800-065
Tribal Survey Questions
Survey of Certification Plan and Reporting Database Users – Evaluating User Access
New
92
15
0
Form
2010-0042
Survey of Certification Plan and Reporting Database Users – Evaluating User Access
TRI National Analysis Website Customer Satisfaction Survey
New
3438
573
0
Form
9600-031
Toxics Release Inventory (TRI) National Analysis User Survey
TRI-MEweb Customer Survey (Toxic Release Inventory – Made Easy Web)
New
3200
320
0
Form
5800-045
RY 2020 TRI-MEweb Application User Survey
Technical Assistance Survey for Support Under the Bipartisan Infrastructure Law (BIL)
New
560
28
0
Form
5900-577
Technical Assistance Survey for Support Under the Bipartisan Infrastructure Law (BIL)
Technical Assistance Survey for Support Under the Bipartisan Infrastructure Law (BIL)
New
560
28
0
Form
6100-077
Technical Assistance Survey for Support Under the Bipartisan Infrastructure Law (BIL) FY 2022
Technical Assistance Survey for Support Under the Bipartisan Infrastructure Law (BIL) v. 3
New
280
14
0
Form
6100-078
Water Infrastructure Technical Assistance Request Form
Toxics Release Inventory (TRI) Program Website Customer Satisfaction Survey
New
8530
1421
0
Form
5800-046
2021 TRI Website Satisfaction Survey
Train-the-Trainer 6-month Post-Survey – Community Lead Awareness segment of Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO-CLA)
New
15
2
0
Form
9600-036
Lead Awareness Curriculum Session Train-the-Trainer Follow-up Survey
Train-the-Trainer Post-Survey – Community Lead Awareness segment of Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO-CLA)
New
15
2
0
Form
9600-035
Train-the-Trainer Post-Survey
Train-the-Trainer Pre-Survey – Community Lead Awareness segment of Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO-CLA)
New
37
6
0
Form
9600-033
Train-the-Trainer Pre-Survey
Understanding Lead Post-Survey – Community Lead Awareness segment of Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO-CLA)
New
15
2
0
Form
9600-034
Understanding Lead Post-Survey
Understanding Lead Pre-Survey – Community Lead Awareness segment of Enhancing Lead Safe Work Practices Through Education and Outreach (ELSWPEO-CLA)
New
37
6
0
Form
9600-032
Understanding Lead Pre-Survey
User interviews to support the development of a redesigned epa.gov/data web area
New
40
30
0
Form and Instruction
5800-084
Script for user interviews to support the development of a redesigned epa.gov/data web area
User interviews to support the development of a revamped epa.gov/data web area
New
40
30
0
Instruction
Viburnum Trend Lead Haul Roads, Operable Unit 2 – St. Joe Minerals Corp, City of Viburnum Superfund Site Community Survey
New
20
2
0
Form
5800-050
Viburnum Trend Lead Haul Roads, Operable Unit 2 – St. Joe Minerals Corp, City of Viburnum Superfund Site Community Survey
e-Manifest Electronic Manifest Questionnaire
New
100
2
0
Form
5800-048
e-Manifest Electronic Manifest Questionnaire
eGRID Customer Satisfaction Survey
New
12
1
0
Form
5800-038
eGRID User Satisfaction Survey
Total Burden Actually Used for Information Collections Under Currently Approved ICR:
105474
17437
0
Total Burden Currently Requested for Information Collections Under Currently Approved ICR:
0
0
0
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