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Appx D_ Follow-up Child Survey (Word)
[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: 251057
OMB.report
HHS/TSDR
OMB 0923-0064
ICR 202212-0923-001
IC 251057
( )
Documents and Forms
Document Name
Document Type
Form 0923-0064
Appx D_ Follow-up Child Survey (Word)
Form and Instruction
0923-0064 Evaluating the Association between Serum Concentrations
P_AppxD_Follow-Up ChldSrvy_v2.(12.1.22).pdf
Form and Instruction
0923-0064 Evaluating the Association between Serum Concentrations
P_AppxD_Follow-Up ChldSrvy_v2.(12.1.22).pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Appx D_ Follow-up Child Survey (Word)
Agency IC Tracking Number:
0923-0064-23BK
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_AppxD_Follow-Up ChldSrvy_v2.(12.1.22).pdf
Yes
No
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:
35
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
140
0
0
0
0
140
Annual IC Time Burden (Hours)
70
0
0
0
0
70
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
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.