Information Collection

Biological and Environmental Sample Collection (PB, EH, TT-HI)

IC 193560 under ICR 201107-0925-001 · OMB 0925-0593.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0593 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10.1 Biological and Environmental Sample Collection (PB, EH, TT-HI)	Form and Instruction
Burden 0 TWF Part SAQ 20110621.docx	Instruction
Burden 0 TWQ Part SAQ 20110621.docx	Instruction
Burden 0 VBD Part SAQ 20110621.doc	Instruction
10.1 Survey Biospecimens Blood and Urine Instruments 20110211.doc	Form and Instruction
Note to File - Biological and Environmental Sample Collection.docx Note to File - Biological and Environmental Sample Collection	IC Document
TWQ Distrib 20110621.doc Environmental Tap Water Pesticide (TWQ) Sample Distribution Script	IC Document
VBD Distrib 20110621.doc Environmental Vacuum Bag Dust (VBD) Sample Distribution Script	IC Document
TWF Distrib 20110621.doc Environmental Tap Water Pharmaceutical (TWF) Sample Distribution Script	IC Document

IC Title:

Biological and Environmental Sample Collection (PB, EH, TT-HI)

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10.1	Survey	Biospecimens Blood and Urine Instruments 20110211.doc	Yes	Yes	Paper Only
Instruction			Burden 0 TWF Part SAQ 20110621.docx	Yes	Yes	Paper Only
Instruction			Burden 0 TWQ Part SAQ 20110621.docx	Yes	Yes	Paper Only
Instruction			Burden 0 VBD Part SAQ 20110621.doc	Yes	Yes	Paper Only

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9,297

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	9,297	9,297
Annual IC Time Burden (Hours)	2,324	2,324
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Note to File - Biological and Environmental Sample Collection	Note to File - Biological and Environmental Sample Collection.docx	04/08/2011
Environmental Tap Water Pesticide (TWQ) Sample Distribution Script	TWQ Distrib 20110621.doc	07/01/2011
Environmental Vacuum Bag Dust (VBD) Sample Distribution Script	VBD Distrib 20110621.doc	07/01/2011
Environmental Tap Water Pharmaceutical (TWF) Sample Distribution Script	TWF Distrib 20110621.doc	07/01/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.