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Jasper and Newton Counties Missouri Lead Exposure Investigation 0923-0048-22GN
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0923-0048 Participant Questionnaire P_AppxE1_JNC MO ATSDR Questionaire.docx Yes No Fillable Fileable
Form and Instruction 0923-0048 Biological Testing Tracking Form P_AppxE2_JNC MO ATSDR Biolgcl Testing Tracking Form.docx Yes No Fillable Fileable
Form 0923-0048 Form 100 P_AppxI1_Form 100- Home Schematic.docx Yes No Fillable Fileable
Form 0923-0048 Form 110 P_AppxI2_Form 110 - Interior Environ Paint Assessment.docx Yes No Fillable Fileable
Form 0923-0048 Form 120 P_AppxI3_Form 120 - Ext Environ Paint Assessment.docx Yes No Fillable Fileable
Form 0923-0048 Form 200 P_AppxI4_Form 200 - Dust Wipe Collection.docx Yes No Fillable Fileable
Form 0923-0048 Form 300 P_AppxI5_Form 300 - Soil Composite Soil Collection.docx Yes No Fillable Fileable
Form 0923-0048 Form 400 P_AppxI6_Form 400 - Private Well Water Collection.docx Yes No Fillable Fileable
Form 0923-0048 Form 500 P_AppxI7_Form 500 - Public Tap Kitchen Tap Collection.docx Yes No Fillable Fileable

Health Consumer Health and Safety

Records of Persons Exposed or Potentially Exposed to Hazardous or Toxic Substances  83 FR 6591

300 0
   
Individuals or Households
 
   0 %

  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 300 0 300 0 0 0
Annual IC Time Burden (Hours) 426 0 426 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA Att1_JNC MO 0923-0048 GenIC SS-A_final.docx 06/23/2022
SSB Att2_JNC MO 0923-0048 GenIC SS-B.docx 06/23/2022
GenIC Submittal Form 0 - JNC MO 0923-0048 GenIC Submittal.docx 06/23/2022
List of Attachments Att3_JNC MO List of Attachments.docx 06/23/2022
EI Final Report Example Att4 Anaconda_Co_Smelter_HC-508.pdf 06/23/2022
Factsheet - Fight Lead Poisoning Healthy Foods Att5A_FctSht - Fight Lead Poisoning Healthy Foods.docx 06/23/2022
Factsheet - Protect Family From Lead in Home Att5B_FctSht - Protect Family from Lead in Home.docx 06/23/2022
Factsheet - Protect Family From Lead in Yard Att5C_FctSht - Protect Family from Lead in Yard.docx 06/23/2022
Safe Gardening Lead Soil Att5D_FctSht - Safe Gardening Lead Soil.docx 06/23/2022
Factsheet - Pregnancy and Lead Att5E_FctSht - Pregnancy and Lead - Stay Healthy During Pregnancy.docx 06/23/2022
PIA Att6 0923-0048 PIA 20220209.pdf 06/23/2022
JNC Exposure Investigation Protocol Att7_ JNC MO EI Protocol.docx 06/23/2022
Project Determination Att8 Project Determination.pdf 06/23/2022
Background Info P_AppxA- JNC MO Background 0923-0048.docx 06/23/2022
EI Fact Sheet P_AppxC1_ JNC MO EI Fact Sheet.docx 06/23/2022
Newton County Recruitment Flyer P_AppxC2_JNC MO Newton County Recruitment Flyer.docx 06/23/2022
Jasper County Recruitment Flyer P_AppxC3_JNC MO Jasper County Recruitment Flyer.docx 06/23/2022
Social Media Recruitment Content P_AppxC4_JNC MO Social Media Recruitment Content.docx 06/23/2022
Privacy Act Statement P_AppxD1_JNC MO ATSDR PrivacyActStmt.docx 06/23/2022
ATSDR Adult Consent Form P_AppxD2_JNC MO ATSDR Adult Consent Form.docx 06/23/2022
ATSDR Parental Permission P_AppxD3_JNC MO ATSDR Parental Perm (eligible child).docx 06/23/2022
ATSDR Child Assent P_AppxD4_JNC MO ATSDR Child Assent Form (minor non-participant).docx 06/23/2022
MDHHS Consent Form P_AppxD5_ JNC MO MDHHS Consent Form.docx 06/23/2022
EPA Consent Form P_AppxD6_ JNC MO EPA Consent Form.docx 06/23/2022
Environmental Sampling Protocols P_AppxF_ JNC MO Environmental Sampling Protocols 0923-0048.docx 06/23/2022
EI Health and Safety Plan P_AppxG_ JNC EI Health and Safety Plan.docx 06/23/2022
Sample Results Letters P_AppxH_ JNC MO Sample Results Letters 0923-0048.docx 06/23/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.