Health Survey

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

OMB: 0923-0042

IC ID: 195214

Information Collection (IC) Details

View Information Collection (IC)

Health Survey
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Health Survey Attachment C Marine Health Survey April 2011.docx Yes Yes Fillable Fileable

Health Immunization Management

 

47,601 0
   
Individuals or Households
 
   33 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 47,601 0 0 0 0 47,601
Annual IC Time Burden (Hours) 35,701 0 0 0 0 35,701
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att D - Invitation Letter Attachment D prenotice and invite ltr USMC 2_11 clean.docx 04/14/2011
Att F - Email Invitation Attachment F email invite 2_11 clean.doc 04/14/2011
Att G - Postcard Reminder/Thank you Attachment G postcard 2_11 clean.doc 04/14/2011
Att H - Email Reminder/Thank you Attachment H email reminder 2_11 clean.doc 04/14/2011
Att I - Reminder Letter Attachment I reminder letter 2_11 clean.doc 04/14/2011
AttJ - Email Reminder Attachment J email reminder 2_11 clean.doc 04/14/2011
Att K - Telephone Reminder Attachment K telephone reminder 2_11 clean.doc 04/14/2011
Att L - Participant Consent Attachment L Consent for Health Study participnats April 2011.doc 04/14/2011
Att M - Registrant Consent Attachment M Consent for registrants April 2011 redline.doc 04/14/2011
Attachment E Letters of invitation from ATSDR April 2011 Attachment E Letters of invitation from ATSDR April 2011.doc 04/25/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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