View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View Generic ICR - OIRA Conclusion

OMB Control No: 0920-1173	ICR Reference No: 201606-0920-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-16TL
Title: Assessment of Potential Exposure from Private Wells for Drinking Water
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/30/2017
	Date Received in OIRA: 06/23/2016
Terms of Clearance: Approved consistent with the understanding that collections submitted under this generic are not considered research and will not include epidemiological studies or the collection of health data. Each GenIC will include a full supporting statement Part A and B.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2020	36 Months From Approved
Responses	19,500	0	0
Time Burden (Hours)	6,252	0	0
Cost Burden (Dollars)	141,987	0	0

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	19,500	19,500
Annual Time Burden (Hours)	6,252	6,252
Annual Cost Burden (Dollars)	141,987	141,987

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Submission of 0920-16TL is a New Generic ICR. Burden values reflect Total Responses and Burden Hours for period of three years.

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