Information Collection

Agency for Toxic Substances and Disease Registry Task Order 15: Message Testing

IC 210596 under ICR 201501-0920-003 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0572 Agency for Toxic Substances and Disease Registry Task Order 15: Message Testing Form and Instruction
0920-0572 ATSDR-Message-Testing_Attachment-2_Screener-Consumers_Cl ATSDR-Message-Testing_Attachment-2_Screener-Consumers_Clean.docx Form and Instruction
0920-0572 ATSDR-Message-Testing_Attachment-5_Consumers ATSDR-Message-Testing_Attachment-5_Consumers.docx Form and Instruction
0920-0572 ATSDR-Message-Testing_Attachment-6_PublicHealthProfessio ATSDR-Message-Testing_Attachment-6_PublicHealthProfessionals.docx Form and Instruction
0920-0572 ATSDR-Message-Testing_Attachment-7_Communitymembers ATSDR-Message-Testing_Attachment-7_Communitymembers.docx Form and Instruction
0920-0572 ATSDR-Message-Testing_Attachment-8_Consent-Form ATSDR-Message-Testing_Attachment-8_Consent-Form.docx Form and Instruction
HMTS Expedited Review Form_508 compliant_TO15 MessageTesting.pdf HMTS Expedited Review Form_508 compliant_TO15 MessageTesting IC Document
ATSDR-Message-Testing_Attachment-1_Background-InformationClean.docx ATSDR-Message-Testing_Attachment-1_Background-Information IC Document
ATSDR-Message-Testing_Attachment-3_Email-Introduction-Community-Members_clean.docx ATSDR-Message-Testing_Attachment-3_Email-Introduction-Community-Members IC Document
ATSDR-Message-Testing_Attachment-4_Email-Introduction-Public-Health-Professionals.docx ATSDR-Message-Testing_Attachment-4_Email-Introduction-Public-Health-Professionals IC Document
ATSDR Message Testing_Attachment -9_BurdenHours.docx ATSDR Message Testing_Attachment -9_BurdenHours IC Document
ATSDR-Message-Testing_List-of-Attachments.docx ATSDR-Message-Testing_List-of-Attachments IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Agency for Toxic Substances and Disease Registry Task Order 15: Message Testing	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0572	ATSDR-Message-Testing_Attachment-6_PublicHealthProfessionals	ATSDR-Message-Testing_Attachment-6_PublicHealthProfessionals.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	ATSDR-Message-Testing_Attachment-7_Communitymembers	ATSDR-Message-Testing_Attachment-7_Communitymembers.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	ATSDR-Message-Testing_Attachment-8_Consent-Form	ATSDR-Message-Testing_Attachment-8_Consent-Form.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	ATSDR-Message-Testing_Attachment-2_Screener-Consumers_Clean	ATSDR-Message-Testing_Attachment-2_Screener-Consumers_Clean.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0572	ATSDR-Message-Testing_Attachment-5_Consumers	ATSDR-Message-Testing_Attachment-5_Consumers.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 28	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	28	28
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
HMTS Expedited Review Form_508 compliant_TO15 MessageTesting	HMTS Expedited Review Form_508 compliant_TO15 MessageTesting.pdf	02/25/2014
ATSDR-Message-Testing_Attachment-1_Background-Information	ATSDR-Message-Testing_Attachment-1_Background-InformationClean.docx	02/25/2014
ATSDR-Message-Testing_Attachment-3_Email-Introduction-Community-Members	ATSDR-Message-Testing_Attachment-3_Email-Introduction-Community-Members_clean.docx	02/25/2014
ATSDR-Message-Testing_Attachment-4_Email-Introduction-Public-Health-Professionals	ATSDR-Message-Testing_Attachment-4_Email-Introduction-Public-Health-Professionals.docx	02/25/2014
ATSDR Message Testing_Attachment -9_BurdenHours	ATSDR Message Testing_Attachment -9_BurdenHours.docx	02/25/2014
ATSDR-Message-Testing_List-of-Attachments	ATSDR-Message-Testing_List-of-Attachments.docx	02/25/2014

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