Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Adult Consent Modified 864 144 4033 Form none Adult consent
Adult Exposure Assessment Questionnaire Modified 864 432 12100 Form none Adult-Child Exposure Assessment Questionnaire
Child Assent Modified 115 19 138 Form and Instruction none Child assent
Community Event Evaluation Survey Modified 489 41 1148 Form none Exposure assessment community event survey
EA Participants (All Ages) - Biological Testing Tracking Modified 1137 379 0 Form none EA participants biological testing tracking
Environmental Sample Collection Form Modified 45 11 308 Form none Environmental sample collection form
Environmental Sampling Consent Modified 45 8 224 Form none Consent for environmental sampling
Exposure Questionnaire for Biological Testing - Child Completed Modified 115 29 210 Form none Child exposure assessment
Exposure Questionnaire for Biological Testing - Parent Proxy Modified 158 40 1120 Form NA Exposure Assessment Child
Household Eligibility Screener Modified 4560 380 10644 Form and Instruction n/a Household Eligibility Screener
Household Recruitment Script for Environmental Sampling Modified 70 6 168 Form and Instruction n/a Household Recruitment Script for Environmental Sampling
Parental Permission Modified 273 46 1288 Form none Parental permission
Total burden requested under this ICR: 8735 1535 31381  
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