Information Collection

Attachments: 17.5 -17.6; 18; 22.2 consent forms, show cards, and dust questionnaire

IC 208235 under ICR 201308-0925-001 · OMB 0925-0406.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0406 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Attachments: 17.5 -17.6; 18; 22.2 consent forms, show cards, and dust questionnaire	Form and Instruction
1 BEEA Show Cards Attachment 17-5 17-6_BEEA_ShowCards_burden.pdf	Form and Instruction
2 BEEA Consent Form - Dust Attachment 18_BEEA_Consent Forms_Dust.pdf	Form and Instruction
3 BEEA Dust Specimen Questionnaire Attachment 22-2_Dust Questionnaire_columns.doc	Form and Instruction

IC Title:

Attachments: 17.5 -17.6; 18; 22.2 consent forms, show cards, and dust questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	1	BEEA Show Cards	Attachment 17-5 17-6_BEEA_ShowCards_burden.pdf	Yes	No	Paper Only
Form and Instruction	2	BEEA Consent Form - Dust	Attachment 18_BEEA_Consent Forms_Dust.pdf	Yes	No	Paper Only
Form and Instruction	3	BEEA Dust Specimen Questionnaire	Attachment 22-2_Dust Questionnaire_columns.doc	Yes	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 160

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Farms

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	160	160
Annual IC Time Burden (Hours)	53	53
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.