Information Collection Request

Morbidity Study of Former Marines, Dependents, and Employees Potentially Exposed to Contaminated Drinking Water at USMC Base Camp Lejeune

ICR 201011-0923-001 · OMB 0923-0042 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Health Survey Form New Available
attachment C survey 11_10 clean.docx Supplementary Document Uploaded 2010-11-22 Available
Supporting Statement B.11.3.10.doc Supporting Statement B Uploaded 2010-11-04 Available
Attachment Q IRB amendment.docx Supplementary Document Uploaded 2010-11-04 Available
Attachment P IRB approval.htm Supplementary Document Uploaded 2010-11-04 Available
Attachment O med rec release.doc Supplementary Document Uploaded 2010-11-04 Available
Attachment N protocol.docx Supplementary Document Uploaded 2010-11-04 Available
Attachment M consent reg.doc Supplementary Document Uploaded 2010-11-04 Available
Attachment L consent.doc Supplementary Document Uploaded 2010-11-04 Available
Attachment K telephone.docx Supplementary Document Uploaded 2010-11-04 Available
Attachment J email reminder.docx Supplementary Document Uploaded 2010-11-04 Repair queued
Attachment H email thank you.docx Supplementary Document Uploaded 2010-11-04 Available
Attachment G postcard.docx Supplementary Document Uploaded 2010-11-04 Available
Attachment F email invite.docx Supplementary Document Uploaded 2010-11-04 Available
Attachment D prenotice.docx Supplementary Document Uploaded 2010-11-04 Available
Attachment E ltr of invitation.docx Supplementary Document Uploaded 2010-11-04 Repair queued
Attachment B 60 day FRN.pdf Supplementary Document Uploaded 2010-11-04 Available
Attachment I reminder.docx Supplementary Document Uploaded 2010-11-04 Available
Attachment A legislation.pdf Supplementary Document Uploaded 2010-11-04 Available
Supporting statement A 11.3.10.doc Supporting Statement A Uploaded 2010-11-04 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
195214 Health Survey Form New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2013 36 Months From Approved
47,601 0 0
35,701 0 0
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Health Survey none, None Health Survey ,   Health Survey

table that charts list of burden
  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 47,601 0 0 47,601 0 0
Annual Time Burden (Hours) 35,701 0 0 35,701 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No