Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Adult Consent Unchanged 1501 250 6079 Form NA Adult Consent
Adult Exposure Assessment Questionnaire Unchanged 1501 751 18267 Form NA Adult Exposure Assessment
Child Assent Modified 199 33 241 Form and Instruction none Assent for Minors
Community Event Evaluation Survey Unchanged 815 68 1654 Form NA PFAS Exposure Assessment Community Event Evaluation
EA Participants (All Ages) - Biological Testing Tracking Unchanged 1975 658 0 Form NA FAS EA Biological Testing Tracking Form
Environmental Sample Collection Form Unchanged 75 38 457 Form NA Environmental Sampling Collection Form
Environmental Sampling Consent Unchanged 75 13 176 Form NA Consent for Environmental Sampling
Exposure Questionnaire for Biological Testing - Child Completed Unchanged 199 50 360 Form NA Exposure Assessment Child
Exposure Questionnaire for Biological Testing - Parent Proxy Unchanged 275 69 1675 Form NA Exposure Assessment Child
Household Eligibility Screener Unchanged 1345 112 2730 Form NA Household Eligibility Screener
Household Recruitment Script for Environmental Sampling Unchanged 117 10 238 Form NA Household Recruitment Script for Environmental Sampling
Parental Permission Unchanged 474 79 1152 Form NA Parental Permission Form
Total burden requested under this ICR: 8551 2131 33029  
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