Information Collection

ASARCO Smelter Exposure Investigation

IC 213701 under ICR 201401-0923-001 · OMB 0923-0048.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-15BI ASARCO Smelter Exposure Investigation	Form and Instruction
0920-15BI Att4_ASARCO EI Participant Questionnaire Att4_ASARCO EI Participant Questionnaire_Oct23_2014.docx	Form and Instruction
Asarco Smelter EI_GenIC SubmissionForm_Oct23_2014.docx Asarco Smelter EI_GenIC SubmissionForm_Oct23_2014	IC Document
Att1_ASARCO EI_SupStatement A_Oct23_2014.docx Att1_ASARCO EI_SupStatement A_Oct23_2014	IC Document
Att2_ASARCO EI_SupStatementB_Oct23_2014.docx Att2_ASARCO EI_SupStatementB_Oct23_2014	IC Document
Att3_ASARCO EI_Permission Assent Consent Forms_Oct23_2014.docx Att3_ASARCO EI_Permission Assent Consent Forms_Oct23_2014	IC Document
Att3A_ASARCO EI_Parental Permission_ChildUnder6_Oct23_2014.docx Att3A_ASARCO EI_Parental Permission_ChildUnder6_Oct23_2014	IC Document
Att3B_ASARCO EI_ParentalPermission_ChildUnder18_Oct23_2014.docx Att3B_ASARCO EI_ParentalPermission_ChildUnder18_Oct23_2014	IC Document
Att3C_ASARCO EI_AssentFormChild7to18_Oct23_2014.docx Att3C_ASARCO EI_AssentFormChild7to18_Oct23_2014	IC Document
Att5_ASARCO EI Research Determination Form_Oct23_2014.pdf Att5_ASARCO EI Research Determination Form_Oct23_2014	IC Document
Att6_ASARCO EI Results Letter Templates Factsheets_Oct23_2014.docx Att6_ASARCO EI Results Letter Templates Factsheets_Oct23_2014	IC Document
Att6A_ASARCO EI_Letter_ChildUnder6_Oct23_2014.docx Att6A_ASARCO EI_Letter_ChildUnder6_Oct23_2014	IC Document
Att6B_ASARCO EI_Letter_Child6to18_Oct23_2014.docx Att6B_ASARCO EI_Letter_Child6to18_Oct23_2014	IC Document
Att6C_ASARCO EI_Letter_PregnantWoman_Oct23_2014.docx Att6C_ASARCO EI_Letter_PregnantWoman_Oct23_2014	IC Document
Att6D_ASARCO EI_Letter Results Inserts_Oct23_2014.docx Att6D_ASARCO EI_Letter Results Inserts_Oct23_2014	IC Document
Att6E_ASARCO EI_Factsheets for Letters_Oct23_2014.docx Att6E_ASARCO EI_Factsheets for Letters_Oct23_2014	IC Document
Att7_Example of Prior Exposure Investigation Final Report_Oct23_2014.pdf Att7_Example of Prior Exposure Investigation Final Report_Oct23_2014	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

ASARCO Smelter Exposure Investigation

Agency IC Tracking Number:

0923-15BI

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-15BI	Att4_ASARCO EI Participant Questionnaire	Att4_ASARCO EI Participant Questionnaire_Oct23_2014.docx		No		Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	200	200
Annual IC Time Burden (Hours)	67	67
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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