Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
MI Biomonitoring Questionnaire Modified 200 173 0 Form none MI Biomonitoring Questionnaire
MI Contact Information Sheet Modified 200 7 0 Form none MI Contact Info Sheet
MI Informed Consent Modified 200 3 0 Form none MI Consent
MI Scheduling Questionnaire Modified 250 29 0 Form none MI Scheduling Questionnaire
MI Screener Modified 2000 167 0 Form none MI screener
MN Clinic Visit Form Modified 250 4 0 Form none MN Clinic Visit
MN Consent Modified 250 13 0 Form none MN Consent
MN Contact Information Modified 250 8 0 Form none MN Contact Information
MN Participant Questionnaire Modified 250 125 0 Form none MN Participant Questionnaire
MN Participation Record Modified 250 4 0 Form none MN Participation Record
MN Recruitment Script Modified 396 33 0 Form none MN Recruitment Script
MN Refusal Questions Modified 107 4 0 Form none MN Refusal Questions
NY - Network Questions - Burmese Modified 50 4 0 Form none NY Network Questions - Burmese
Form none Network Questions - Burmese translation
NY Consent Modified 200 3 0 Form none NY Consent
NY Consent - Burmese Modified 50 1 0 Form none NY Consent - Burmese
Form none NY Consent - Burmese translation
NY Interview - Burmese Modified 50 50 0 Form none NY Interview - Burmese
Form none Interview - Burmese translation
NY Mail-in Screener Modified 518 43 0 Form none NY Mail-in Screener
NY Nonresponder Script Modified 864 72 0 Form none NY Nonresponder Script
NY Online Screener Modified 778 65 0 Form none NY Online Screener
NY Questionnaire Modified 200 100 0 Form none NY Questionnaire
NY Responder Script Modified 259 22 0 Form none NY Responder Script
NY Screener - Burmese Modified 92 8 0 Form none NY Screener - Burmese
Form none Screener - Burmese translation
Total burden requested under this ICR: 7664 938 0  
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