Colorado Smelter Exposure Investigation

ATSDR Exposure Investigations (EIs)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0048 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Colorado Smelter Exposure Investigation Form and Instruction
1 Questionnaire for Colorado Smelter EI Att4_Colorado EI Questionnaire_Revised 06 SEP 13 Clean copy (2).docx Form and Instruction
Colorado Smelter EI_GenIC_8_5_2013.docx Colorado Smelter submission IC Document
Att3_AssentConsentParental Permission_8 5 2013.docx Assent/Consent IC Document
Att5_Human Subjects Documentation_8_5_2013.pdf Non-research determination IC Document
Att1_Colorado Smelter EI_SupStA_9_6_2013_CLEAN.docx Part A Supporting Statement IC Document
Att2_Colorado Smelter EI_SupStB_9_6_2013 CLEAN.docx Part B Supporting Statement IC Document
Att9_Example of Prior Exposure Investigation Final Report.pdf Example of Prior EI Report to Community IC Document
Att8 Response Letter Normal Results_9_6_2013_CLEAN.docx Example Letter IC Document

Information Collection (IC) Details

IC Title:	Colorado Smelter Exposure Investigation	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Questionnaire for Colorado Smelter EI	Att4_Colorado EI Questionnaire_Revised 06 SEP 13 Clean copy (2).docx		No		Paper Only

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records
Title: Records of Persons Exposed or Potentially Exposed to Hazardous or Toxic Substances	FR Citation: 53 FR 157

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 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	300	0	0	0	0	0
Annual IC Time Burden (Hours)	100	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Colorado Smelter submission	Colorado Smelter EI_GenIC_8_5_2013.docx	08/07/2013
Assent/Consent	Att3_AssentConsentParental Permission_8 5 2013.docx	08/07/2013
Non-research determination	Att5_Human Subjects Documentation_8_5_2013.pdf	08/07/2013
Part A Supporting Statement	Att1_Colorado Smelter EI_SupStA_9_6_2013_CLEAN.docx	09/06/2013
Part B Supporting Statement	Att2_Colorado Smelter EI_SupStB_9_6_2013 CLEAN.docx	09/06/2013
Example of Prior EI Report to Community	Att9_Example of Prior Exposure Investigation Final Report.pdf	09/06/2013
Example Letter	Att8 Response Letter Normal Results_9_6_2013_CLEAN.docx	09/06/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.