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Appx D _Child Follow-up Survey REDCap (Online)
[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: 251058
OMB.report
HHS/TSDR
OMB 0923-0064
ICR 202212-0923-001
IC 251058
( )
Documents and Forms
Document Name
Document Type
Form 0923-0064
Appx D _Child Follow-up Survey REDCap (Online)
Form and Instruction
0923-0064 Evaluating the Association between Serum Concentrations
P_ApndxD1_F-UChldSrvy_REDCap.pdf
Form and Instruction
0923-0064 Evaluating the Association between Serum Concentrations
P_ApndxD1_F-UChldSrvy_REDCap.pdf
Form and Instruction
P_ApndxD_F-UChldSrvy (Word)_20221213.docx
Follow-up Child Survey (Word)
IC Document
P_ApndxD_F-UChldSrvy (Word)_20221213.docx
Follow-up Child Survey (Word)
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Appx D _Child Follow-up Survey REDCap (Online)
Agency IC Tracking Number:
0923-0064-22BK
Is this a Common Form?
No
IC Status:
Modified
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
0923-0064
Evaluating the Association between Serum Concentrations of Per- and Polyfluoroalkyl Substances (PFAS) and Symptoms and Diagnoses of Selected Acute Viral Illnesses Child (< 18 years of age) Follow-up
P_ApndxD1_F-UChldSrvy_REDCap.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
Records of Persons Exposed or Potentially Exposed to Hazardous or Toxic Substances (retrievable by name or SSN)
FR Citation:
76 FR 4431
Number of Respondents:
104
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
416
0
0
0
0
416
Annual IC Time Burden (Hours)
174
0
0
0
0
174
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Follow-up Child Survey (Word)
P_ApndxD_F-UChldSrvy (Word)_20221213.docx
12/14/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.