Parental Permission

Per- or Polyfluoroalkyl Substances Exposure Assessments (PFAS EAs)

Documents and Forms

Document Name Document Type
Parental Permission Form
Parental permission PrtApndxB3_Parental Permission Form_20220609.docx Form
Parental permission PrtApndxB3_Parental Permission Form_20220609.docx Form

Information Collection (IC) Details

IC Title:	Parental Permission	Agency IC Tracking Number:

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	none	Parental permission	PrtApndxB3_Parental Permission Form_20220609.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances	FR Citation: 76 FR 4432

Number of Respondents: 273	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	273	-201	474
Annual IC Time Burden (Hours)	46	-33	79
Annual IC Cost Burden (Dollars)	1,288	136	1,152

Documents for IC

Title	Document	Date Uploaded
No associated records found

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