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Drinking Water Exposure Investigation - Dimock, PA 0923-17AOV
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Dimock Water Exposure Investigation Att4 Qstnnr Dimock EI .docx Yes Yes Fillable Fileable

Health Consumer Health and Safety

Records of Persons Exposed or Potentially Exposed to Hazardous or Toxic Substances  59 FR 67085

20 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 20 0 20 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
Supporting Statement A Att1 SSA 0923-0048 Dimock EI.docx 06/08/2017
Supporting Statement B Att2 SSB 0923-0048 Dimock EI .docx 06/08/2017
Consent Att3 Cnsnt Frm Dimock EI .docx 06/08/2017
Protocol Att5 Dimock EI Protocol Final.docx 06/08/2017
Sample results letter Att6 EI Smpl Rslts Lttr Dimock EI .docx 06/08/2017
Report example Att7 Exmpl EI Report .doc 06/08/2017
Research determination Att8 NCEH-ATSDR Research Determination Form Dimock EI -OSSigned.pdf 06/08/2017
Invitation and Fact Sheet Att9 Lttr of invittn Fct Sht Dimock EI.docx 06/08/2017
GenIC request for approval Dimock EI GenIC Sbmssn Frm.docx 06/08/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.