Information Collection

Climate and Economic Justice Screening Tool-Data Survey

IC 255792 under ICR 202206-0331-001 · OMB 0331-0004.

Documents and Forms

Document Name Document Type
Form 0331-0004-002 Climate and Economic Justice Screening Tool-Data Survey Form and Instruction
0331-0004-002 CEJST-Data Survey CEQ form 002_CEJST v1.0 Data Survey.docx Form and Instruction
CEQ form 002_fast-track-PRA-submission-data-survey.docx PRA Fast Track-CEJST Data Survey IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Climate and Economic Justice Screening Tool-Data Survey	Agency IC Tracking Number:

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	0331-0004-002	CEJST-Data Survey	CEQ form 002_CEJST v1.0 Data Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
PRA Fast Track-CEJST Data Survey	CEQ form 002_fast-track-PRA-submission-data-survey.docx	09/09/2022

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