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View Information Collection (IC)

Supplemental Exposure Investigation at Select PFAS Exposure Assessment Sites 0923-0048-21GQ
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0923-0048 NA Yes Yes Fillable Fileable
Form and Instruction 0923-0048 NA Yes Yes Fillable Fileable
Form and Instruction 0923-0048 NA Yes Yes Fillable Fileable
Form and Instruction 0923-0048 NA No   Paper Only
Form and Instruction 0923-0048 NA Yes Yes Fillable Fileable
Form and Instruction 0923-0048 NA Yes Yes Fillable Fileable
Form and Instruction 0923-0048 NA No   Paper Only
Form and Instruction 0923-0048 NA Yes Yes Fillable Fileable
Form and Instruction 0923-0048 NA Yes Yes Fillable Fileable
Form and Instruction 0923-0048 NA Yes Yes Fillable Fileable

Health Public Health Monitoring

09-19-0001 - Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances  76 FR 4431

600 0
   
Individuals or Households
 
   55 %

  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 600 0 600 0 0 0
Annual IC Time Burden (Hours) 351 0 351 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
0923-0048 GenIC Submission Form 02/17/2022
Supporting Statement A 02/17/2022
Supporting Statement B 02/17/2022
Environmental Sampling Protocol 02/17/2022
Household Recruitment Letter 02/17/2022
Appointment Verification Letter 02/17/2022
Adult Consent 1 02/17/2022
Adult Consent 2 02/17/2022
Parental Permission 02/17/2022
Assent Form 02/17/2022
Sampling and Analysis Plan (SAP) 02/17/2022
Health and Safety Plan 02/17/2022
Results Letter - Dust Only 02/17/2022
Results Letter - Robust 02/17/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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