DEPARTMENT OF ENERGY HEALTH STUDIES

ICR 198306-1901-007

OMB: 1901-0262

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
135832 Migrated
ICR Details
1901-0262 198306-1901-007
Historical Active
DOE/ENDEP
DEPARTMENT OF ENERGY HEALTH STUDIES
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 07/09/1983
Retrieve Notice of Action (NOA) 06/20/1983
  Inventory as of this Action Requested Previously Approved
07/31/1986 07/31/1986
11,107 0 0
3,832 0 0
0 0 0

FORMS ER-485A AND B WILL BE USED IN TELEPHONE SURVEYS ON THE NON-FATAL HEALTH EFFECTS ASSOCIATED WITH OCCUPATIONAL EXPOSURES TO RADIATION. TH RESPONDENTS ARE CURRENT AND PAST WORKERS AT FACILITIES OPERATED BY DOE ITS CONTRACTORS AND THEIR PREDECESSORS.

None
None


No

1
IC Title Form No. Form Name
DEPARTMENT OF ENERGY HEALTH STUDIES ER-485A, ER-485B

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 11,107 0 0 11,107 0 0
Annual Time Burden (Hours) 3,832 0 0 3,832 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/20/1983


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