Eligibility Screening

[ATSDR] Human Health Effects of Drinking Water Exposures to Per- and Polyfluoroalkyl Substances (PFAS): A Multi-site Cross-sectional Study

OMB: 0923-0063

IC ID: 239035

Documents and Forms
Information Collection (IC) Details

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Eligibility Screening
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none Eligibility screener M_Att04 ElgbltyScrng_20201027_updt.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances  76 FR 4432

7,982 0
   
Individuals or Households
 
   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 7,982 0 0 0 0 7,982
Annual IC Time Burden (Hours) 1,330 0 0 0 0 1,330
Annual IC Cost Burden (Dollars) 33,231 0 0 0 0 33,231

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

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