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Exposure Investigation - Blood Lead Levels in Iola, Kansas 17EL
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA Iola KS Exposure Investigation Questionnaire Att4 Questionnaire BLL Iola OMB 0923-0048.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

09-19-0001 - Records of Persons Exposed or Potentially Exposed to Hazardous or Toxic Substances  59 FR 67085

300 0
   
Individuals or Households
 
   100 %

  Approved 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 500 0 500 0 0 0
Annual IC Time Burden (Hours) 250 0 250 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Parental Permission Form for Venous Blood Sampling for Lead and Questionnaire - Children Less Than 18 Years of Age Att3A Parental Permission_BLL in Iola OMB 0923-0048 .docx 11/14/2016
Assent Form for Blood Lead and Questionnaire Youth 6-17 Years of Age Att3B Assent Form_BLL Iola OMB 0923-0048 .docx 11/14/2016
Consent Form for Venous Blood Lead Testing and Questionnaire - Pregnant Women and Women of Childbearing Age Att3C Consent Form_BLL Iola 0923-0048.docx 11/14/2016
Research Determination Att5_Human Research Determination_Iola EI 0923-0048.pdf 11/14/2016
Sample Results Letter - Younger than 18 Years of Age Att6A letter for child results BBL Iola OMB 0923-0048.docx 11/14/2016
Sample Results Letter - Pregnant Woman or Woman of Child Bearing Age Att6B letter for women results BLL Iola OMB 0923-0048 .docx 11/14/2016
Blood Lead Levels - Inserts for Letters Att6C letter inserts BLL IOla OMB 0923-0048.docx 11/14/2016
Fact Sheets Att6D fact sheet inserts BLL Iola OMB 0923-0048.docx 11/14/2016
Exposure Investigation Report - Perfluorochemical Serum Sampling Decatur, AL Att7 PFC Serum Sampling_Decatur, AL_HC_EI_04-01-2013_FINAL_26MAR2013.pdf 11/14/2016
Supporting Statement B Att2_BLL Iola KS EI SupStatement B - 0923-0048 .docx 11/14/2016
Advance Notification of Urgent Exposure Investigationo Advance Notification of Urgent Exposure Investigation - Blood Lead Levels in Iola KS Exposure Investigation.msg 11/14/2016
Supportinig Statement A Att1_BLL Iola KS EI SupStatement A - 0923-0048_OMB 11-21-2016 ATSDR final.docx 11/21/2016
Exposure Investigation Protocol Blood Lead Levels - Iola, KS Att8 IOLA KS EI Protocl 08 nov 2016 FINALclean OMB comments 11-21 atsdr final.docx 11/21/2016
GenI Submission Form BBL Iola OMB_GenIC SubmissionForm_0923-0048 edits_OMB 11-21 ATSDR final.docx 11/21/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.