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

View Information Collection (IC)

Follow Up Biologic Testing for Exposure to Arsenic ASARCO Hayden Smelter Site, Hayden & Winkelman, Arizona Exposure Investigation 0923-0048-17ALA
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA NA Yes Yes Fillable Fileable
Instruction NA No   Paper Only

Health Public Health Monitoring

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

60 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 60 0 60 0 0 0
Annual IC Time Burden (Hours) 30 0 30 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Parental Permission Form for Children 6 to less than 18 Years of Age 05/19/2017
Assent Form for Children and Youth 7 to less than 18 Years of Age 05/19/2017
Consent Form for Adults Aged 18 years and Over 05/19/2017
Non-Research Determination 05/19/2017
Sample Results Letter to the Parent of a Participant 6 to <18 Years of Age – Total Arsenic Below Follow-up Level 05/19/2017
Sample Results Letter to the Parent of a Participant (6 to <18 Years of Age) – Total Arsenic Above Follow-up Level, Organic Arsenic Not Elevated, Inorganic Arsenic Elevated 05/19/2017
Sample Results Letter to the Parent of a Participant (6 to <18 Years of Age) - Total Arsenic Above Follow-up Level, Organic Arsenic Elevated, Inorganic Arsenic Not Elevated 05/19/2017
Sample Results Letter to the Parent of a Participant (6 to <18 Years of Age) - Total Arsenic Above Follow-up Level, Organic Arsenic Elevated, Inorganic Arsenic Elevated 05/19/2017
Sample Results Letter to a Pregnant Woman or Woman of Child Bearing Age (15 to <45 years) - Total Arsenic Below Follow-up Level 05/19/2017
Sample Results Letter to a Pregnant Woman or Woman of Child Bearing Age (15 to <45 years) – Total Arsenic Above Follow-up Level, Organic Arsenic Not Elevated, Inorganic Arsenic Elevated 05/19/2017
Sample Results Letter to a Pregnant Woman or Woman of Child Bearing Age (15 to <45 years) - Total Arsenic Above Follow-up Level, Organic Arsenic Elevated, Inorganic Arsenic Not Elevated 05/19/2017
Sample Results Letter to a Pregnant Woman or Woman of Child Bearing Age (15 to <45 years) - Total Arsenic Above Follow-up Level, Organic Arsenic Elevated, Inorganic Arsenic Elevated 05/19/2017
Health Consultation - Exposure Investigation ASARCO HAYDEN SMELTER SITE 05/19/2017
Arsenic Retest Recruitment Letter 05/19/2017
Hayden & Winkelman Site Map and Demographics 05/19/2017
Tips for Reducing Exposure to Arsenic 05/19/2017
Generic Information Collection (GenIC) Submittal Form for ATSDR Exposure Investigations (EIs) (0923-0048) 05/19/2017
Supporting Statement A 05/19/2017
Supporting Statement B 05/19/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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