Blood Draw Form

Anniston Community Health Survey: Follow up and Dioxin Analyses (ACHS-II)

OMB: 0923-0049

IC ID: 206835

Documents and Forms
Document Name
Document Type
Other-WORD
Information Collection (IC) Details

View Information Collection (IC)

Blood Draw Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Att3.12_BloodDrawForm.docx Yes Yes Fillable Printable

Health Immunization Management

09-19-0001 Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances  53 FR 30720

250 0
   
Individuals or Households
 
   100 %

  Approved 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 250 0 250 0 0 0
Annual IC Time Burden (Hours) 8 0 8 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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