Information Collection

Camp Lejeune Drinking Water Notification Registry

IC 185160 under ICR 202303-0712-001 · OMB 0712-0011.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0712-0011 can be found here:

Documents and Forms

Document Name Document Type
0703-0057_Collection Instrument.pdf www.marines.mil/clwater Other-Website Screenshots

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Camp Lejeune Drinking Water Notification Registry	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-Website Screenshots			0703-0057_Collection Instrument.pdf	http://www.marines.mil/clwater	Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 85 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	10,000	0	10,000
Annual IC Time Burden (Hours)	1,000	0	1,000
Annual IC Cost Burden (Dollars)	28,010	4,780	23,230

Documents for IC

Title	Document	Date Uploaded
No associated records found

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