Information Collection Request

Biomonitoring of Great Lakes Populations Program

ICR 201304-0923-002 · OMB 0923-0044 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
MI Contact Information Sheet Form Modified Available
NY - Network Questions - Burmese Form Modified Available
NY Interview - Burmese Form Modified Repair queued
NY Consent - Burmese Form Modified Available
NY Screener - Burmese Form Modified Repair queued
NY Questionnaire Form Modified Available
NY Consent Form Modified Available
NY Responder Script Form Modified Available
NY Nonresponder Script Form Modified Available
NY Online Screener Form Modified Repair queued
NY Mail-in Screener Form Modified Available
MN Participation Record Form Modified Available
MN Clinic Visit Form Form Modified Available
MN Participant Questionnaire Form Modified Available
MN Contact Information Form Modified Available
MN Consent Form Modified Available
MN Refusal Questions Form Modified Available
MN Recruitment Script Form Modified Available
MI Biomonitoring Questionnaire Form Modified Available
MI Informed Consent Form Modified Available
MI Scheduling Questionnaire Form Modified Available
MI Screener Form Modified Available
GreatLakes_SSA_20130403_trkchng1.docx Supplementary Document Uploaded 2013-04-10 Available
GreatLakes_SSA_20130403.docx Supplementary Document Uploaded 2013-04-10 Available
Change Request Justification ICR 0923-0044 Biomonitoring of the Great Lakes Populations Program.docx Justification for No Material/Nonsubstantive Change Uploaded 2013-04-10 Available
Att6a_NY_FctSht_LA_20120619.docx Supplementary Document Uploaded 2012-09-27 Available
Att4a1._MI_Dtrt_AOC_Brochure_20120712.pdf Supplementary Document Uploaded 2012-09-27 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
204369 MI Contact Information Sheet Form Modified
201475 NY - Network Questions - Burmese Form Modified
201474 NY Interview - Burmese Form Modified
201473 NY Consent - Burmese Form Modified
201472 NY Screener - Burmese Form Modified
201471 NY Questionnaire Form Modified
201470 NY Consent Form Modified
201469 NY Responder Script Form Modified
201468 NY Nonresponder Script Form Modified
201467 NY Online Screener Form Modified
201466 NY Mail-in Screener Form Modified
201465 MN Participation Record Form Modified
201464 MN Clinic Visit Form Form Modified
201463 MN Participant Questionnaire Form Modified
201462 MN Contact Information Form Modified
201461 MN Consent Form Modified
201460 MN Refusal Questions Form Modified
201459 MN Recruitment Script Form Modified
201458 MI Biomonitoring Questionnaire Form Modified
201457 MI Informed Consent Form Modified
201456 MI Scheduling Questionnaire Form Modified
201455 MI Screener Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2015 10/31/2015 10/31/2015
7,664 0 7,664
938 0 938
0 0 0





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 7,664 7,664 0 0 0 0
Annual Time Burden (Hours) 938 938 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No