Information Collection

Tremolite Asbestos Registry - Baseline Surveys

IC 43624 under ICR 200909-0923-001 · OMB 0923-0039.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form No number Tremolite Asbestos Registry - Baseline Surveys	Form
No number TAR Adult and Child Baseline Surveys Appendix D (Baseline Surveys).doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 Baseline Surveys	Appendix D (Baseline Surveys).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: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	500	-1,000	1,500
Annual IC Time Burden (Hours)	250	-430	680
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.