Appx B_ Parental Permission, Child Assent, and Initial Survey (paper) – Child 7-17 Initial Survey

[ATSDR] Evaluating the Association between Serum Concentrations of Per- and Polyfluoroalkyl Substances (PFAS) and Symptoms and Diagnoses of Selected Acute Viral Illnesses

OMB: 0923-0064

IC ID: 251056

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Appx B_ Parental Permission, Child Assent, and Initial Survey (paper) – Child 7-17 Initial Survey 0923-0064-23BK
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0923-0064 Parental Permission Form (<18 years of age), Child Assent Form (7 to <18 years), and Initial Child Survey (<18 years of age) P_ApndxB_InChldSrvyAssntPrmssn.docx No   Fillable Fileable

Health Public Health Monitoring

Records of Persons Exposed or Potentially Exposed to Hazardous or Toxic Substances (retrievable by name or SSN)  76 FR 4431

139 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 139 0 0 0 0 139
Annual IC Time Burden (Hours) 70 0 0 0 0 70
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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