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⚠️ Notice: This information collection may be referencing outdated material.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

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:

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 %

	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.