View Information Collection (IC)

View Information Collection (IC)

IC Title:	CHIPS Environmental Questionnaire Information Collection	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
Other-Information Collection			PRA Environmental Questionnaire CLEAN.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

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	200	0	200	0	0	0
Annual IC Time Burden (Hours)	1,600	0	1,600	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Published FRN	Emergency FRN Environmental Questionnaire.pdf	03/03/2023
Supporting Statement	CHIPS Environmental Questionnaire Supporting Statement A CLEAN.docx	03/24/2023
Part B	Supporting Statement B for EQ 3_23_23.docx	03/24/2023

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