Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
MI Biomonitoring Questionnaire Modified 175 152 0 Form none
MI Contact Information Sheet Unchanged 200 7 0 Form none
MI Informed Consent Unchanged 200 3 0 Form none
MI Scheduling Questionnaire Unchanged 250 29 0 Form none
MI Screener Unchanged 2000 167 0 Form none
MN Clinic Visit Form Unchanged 250 4 0 Form none
MN Consent Unchanged 250 13 0 Form none
MN Contact Information Unchanged 250 8 0 Form none
MN Participant Questionnaire Unchanged 250 125 0 Form none
MN Participation Record Unchanged 250 4 0 Form none
MN Recruitment Script Unchanged 396 33 0 Form none
MN Refusal Questions Unchanged 107 4 0 Form none
Mi Informed Consent for Repeat Appointments New 25 0 0 Form and Instruction 0923-0044
Michigan Biomonitoring of Great Lakes Populations New 50 43 0 Form and Instruction 0923-0044
Michigan Department of Community Health Telephone Questions for Scheduling (repeated appointments) New 25 3 0 Form and Instruction 0923-0044
NY - Network Questions - Burmese Unchanged 100 8 0 Form none
Form none
NY Consent Unchanged 200 3 0 Form none
NY Consent - Burmese Unchanged 100 2 0 Form none
Form none
NY Interview - Burmese Unchanged 100 100 0 Form none
Form none
NY Mail-in Screener Unchanged 518 43 0 Form none
NY Nonresponder Script Unchanged 864 72 0 Form none
NY Online Screener Unchanged 778 65 0 Form none
NY Questionnaire Unchanged 200 100 0 Form none
NY Responder Script Unchanged 259 22 0 Form none
NY Screener - Burmese Unchanged 184 15 0 Form none
Form none
Total burden requested under this ICR: 7981 1025 0  
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