Adult and Child Follow-Up

Tremolite Asbestos Registry

Documents and Forms

Document Name Document Type
Form No number Adult and Child Follow-Up Form
No number TAR Adult and Child Follow-up Survey Appendix_E_(Followup_Surveys)_edit.doc Form

Information Collection (IC) Details

IC Title:	Adult and Child Follow-Up	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	No number	TAR Adult and Child Follow-up Survey	Appendix_E_(Followup_Surveys)_edit.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-19-0001 Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances	FR Citation: 59 FR 67085

Number of Respondents: 1,500	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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,500	0	1,500
Annual IC Time Burden (Hours)	750	250	500
Annual IC Cost Burden (Dollars)	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.