SYMPTOM AND DISEASE PREVALENCE QUESTIONNAIRE AND SUPPLEMENTAL MODULES

ICR 199301-0923-001

OMB: 0923-0012

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0923-0012 199301-0923-001
Historical Active
HHS/TSDR
SYMPTOM AND DISEASE PREVALENCE QUESTIONNAIRE AND SUPPLEMENTAL MODULES
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 04/19/1993
Retrieve Notice of Action (NOA) 01/14/1993
  Inventory as of this Action Requested Previously Approved
02/28/1996 02/28/1996
13,500 0 0
5,604 0 0
0 0 0

SYMPTOM AND DISEASE PREVALENCE AND BIOMARKER SURVEYS WILL BE CONDUCTED ON PRIVATE CITIZENS LIVING NEAR HAZARDOUS WASTE SITES WHO MAY HAVE BEE EXPOSED TO HAZARDOUS SUBSTANCES AND ON PRIVATE CITIZENS LIVING IN COMPARISON COMMUNITIES. THE STUDIES CONSIST OF A CORE QUESTIONNAIRE AND SUPPLEMENTAL ORGAN MODULES TO ASSESS THE ADVERSE EFFECT ON KIDNEY,

None
None


No

1
IC Title Form No. Form Name
SYMPTOM AND DISEASE PREVALENCE QUESTIONNAIRE AND SUPPLEMENTAL MODULES

  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 13,500 0 0 13,500 0 0
Annual Time Burden (Hours) 5,604 0 0 5,604 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.
01/14/1993


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