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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 Hayden, Arizona Smelter Exposure Investigation Questionaire Att 4 Qstnnr Fllup BlgicTstng Expsre Arsnc Hayden A.pdf NA Yes Yes Fillable Fileable
Instruction Att 9 Urn Arsnc Lvls in Hayden AZ E Uin Cllctn Instrctns.docx 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 Att 3A Prentl Permssn_Fllup BlgicTstng Expsre Arsnc Hayden AZ .docx 05/19/2017
Assent Form for Children and Youth 7 to less than 18 Years of Age Att 3B Assnt Frm_Fllup BlgicTstng Expsre Arsnc Hayden A.docx 05/19/2017
Consent Form for Adults Aged 18 years and Over Att 3C Cnst Frm- Fllup BlgicTstng Expsre Arsnc Hayden A.docx 05/19/2017
Non-Research Determination Att 5 RDF Fllup BlgicTstng Expsre Arsnc Hayden AZ.pdf 05/19/2017
Sample Results Letter to the Parent of a Participant 6 to <18 Years of Age – Total Arsenic Below Follow-up Level Att 6A Rslts lttr Prnt of 6 to 18 - Ttl Arsnc below .docx 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 Att 6B Rslts Lttr Prtcpnt 6 to 18 – Ttl Abve, Org Not, Inorg Elvtd .docx 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 Att 6C Rslts Lttr Prtcpnt 6 to 18 - Ttl Abve, Org Elvtd, Inorg Not Elvtd .docx 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 Att 6D Rslts Lttr Prtcpnt 6 to 18 - Ttl Abv, Org Elvtd, Inorg Elvtd .docx 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 Att 6E Rslts Lttr Prgnnt Wmn 15 to 45 - Ttl Arsnc Blw .docx 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 Att 6F Rslts Lttr Prgnnt Wmn 15 to 45 years – Ttl Abv, Org Not, Inorg Elvtd .docx 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 Att 6G Rslts Lttr Prgnnt Wmn 15 to 45 years - Ttl Abve Org Elvted Inorg Not Elvtd.docx 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 Att 6H Rslts Lttr Prgnnt Wmn 15 to 45 years - Ttl Abve, Org Elvtd, Inorg Elvtd .docx 05/19/2017
Health Consultation - Exposure Investigation ASARCO HAYDEN SMELTER SITE Att 7 AsarcoHaydenSmelterSite HC EI Report.pdf 05/19/2017
Arsenic Retest Recruitment Letter Att 8 Urn Arsnc Lvls Hayden AZ Arsnc Rtst Rcruitmnt Lttr.docx 05/19/2017
Hayden & Winkelman Site Map and Demographics Att 10 Hayden and Winkelman St Map Dmgrphcs.docx 05/19/2017
Tips for Reducing Exposure to Arsenic Att 11 Tips for Reducing Exposure to Arsenic.docx 05/19/2017
Generic Information Collection (GenIC) Submittal Form for ATSDR Exposure Investigations (EIs) (0923-0048) Fllup BlgicTstng Expsre Arsnc Hayden AZ EIGenICSbmssnFrm.docx 05/19/2017
Supporting Statement A Att 1 Fllup BlgicTstng Expsre Arsnc Hayden AZ EI SSA.docx 05/19/2017
Supporting Statement B Att 2 Fllup BlgicTstng Expsre Arsnc Hayden AZ EI SS B.docx 05/19/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.