View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Registration and Feedback for the 2021 Place & Health Conference	Agency IC Tracking Number:	0923-22AX

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	0920-1050	Registration Form	Attachment_A_Registration_Form_Text_2021_final.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Post Event Survey	Attachment_B_Post_event_Survey_Text_2021.Edit11.12.tkb_final.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Record of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances	FR Citation: 76 FR 4431

Number of Respondents: 1,120	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	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	1,120	0	1,120	0	0	0
Annual IC Time Burden (Hours)	43	0	43	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Template Form	ATSDR 0923-1050 GnrcClrncQualFdbkTmpltapprvlFrm exp 20220531_v3_final.docx	11/19/2021
Email Invitation	Attachment_C_Email_Post_event_survey_2021.docx	11/19/2021

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