Colorado Smelter Exposure Investigation

ATSDR Exposure Investigations (EIs)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0048 can be found here:

Documents and Forms

Document Name Document Type
Colorado Smelter Exposure Investigation Form
Colorado Smelter Questionnaire Att4_Pueblo Colorado Smelter EI Questnnre 8_5_2013.docx Form
Att1_Colorado Smelter EI_SupStA_8_5_2013.docx Supporting Statement A IC Document
Att2_Colorado Smelter EI_SupStB_8_5_2013.docx Supporting Statement B IC Document
Colorado Smelter EI_GenIC_8_5_2013.docx Colorado Smelter submission IC Document
Att3_AssentConsentParental Permission_8 5 2013.docx Assent/Consent IC Document
Att5_Human Subjects Documentation_8_5_2013.pdf Non-research determination IC Document

Information Collection (IC) Details

IC Title:	Colorado Smelter Exposure Investigation	Agency IC Tracking Number:

IC Status: Modified

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
Form	none	Colorado Smelter Questionnaire	Att4_Pueblo Colorado Smelter EI Questnnre 8_5_2013.docx		Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records
Title: Records of Persons Exposed or Potentially Exposed to Hazardous or Toxic Substances	FR Citation: 53 FR 157

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	Att1_Colorado Smelter EI_SupStA_8_5_2013.docx	08/07/2013
Supporting Statement B	Att2_Colorado Smelter EI_SupStB_8_5_2013.docx	08/07/2013
Colorado Smelter submission	Colorado Smelter EI_GenIC_8_5_2013.docx	08/07/2013
Assent/Consent	Att3_AssentConsentParental Permission_8 5 2013.docx	08/07/2013
Non-research determination	Att5_Human Subjects Documentation_8_5_2013.pdf	08/07/2013

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