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: 202003-0920-005
Status: Historical Active	Previous ICR Reference No: 201606-0920-005
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1173
Title: Assessment of Potential Exposure from Private Wells for Drinking Water
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/04/2021
	Date Received in OIRA: 03/23/2020
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	01/31/2024	36 Months From Approved	12/31/2020
Responses	19,500	0	19,500
Time Burden (Hours)	6,252	0	6,252
Cost Burden (Dollars)	156,175	0	141,987

Annual Cost to Federal Government: $469,600

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Shari Steinberg 404 639-4942 sxw2@cdc.gov

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