Medical Examination, Biospecimen Collection, and Exposure Monitoring

Exposure Assessment and Epidemiological Study of U.S. Workers Exposed to Carbon Nanotubes and Nanofibers

Documents and Forms

Document Name Document Type
Exam and Specimen.docx Other-Examination

Information Collection (IC) Details

IC Title:	Medical Examination, Biospecimen Collection, and Exposure Monitoring	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
Other-Examination			Exam and Specimen.docx		No		Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title: Occupational Health Epidemiological Studies and EEOICPA Records	FR Citation: 76 FR 34706

Number of Respondents: 33	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
Annual Number of Responses for this IC	33	33
Annual IC Time Burden (Hours)	43	43
Annual IC Cost Burden (Dollars)	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.