View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Methyl Bromide Release at a Condominium Resort - U.S. Virgin Islands 15BDY
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None ACE Adult/Child/Pet Survey Attachment B_General Survey_Methyl Bromide.docx None No   Paper Only
Form and Instruction NA ACE General Survey Methyl Bromide FINAL Attachment B_General Survey_Methyl Bromide_FINAL ADULT_4-7-2015.docx NA No   Paper Only

Health Public Health Monitoring

09-19-0001 Records of Persons Exposed or Potentially Exposed to Hazardous   53 FR 30702

40 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 40 0 0 0 0 40
Annual IC Time Burden (Hours) 17 0 0 0 0 17
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
U.S. Virgin Islands Request for Assistance Attachment A_EpiAid_request_MethylBrom.pdf 04/03/2015
Medical Chart Abstraction Form (if required) Attachment C_MedChartAbstrct Form.docx 04/03/2015
ACE Survey Consent Form Attachment D_ACE Survey Consent Form_Methyl Bromide.docx 04/03/2015
Request for ACE Investigation Request ACE Investigation Form_Methyl Bromide Signed.pdf 04/03/2015
Supporting Statement B Supporting Statement B_Methyl Bromide.docx 04/03/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.