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Federal forms, ICRs, and supporting documents

Information Collection

Perfluorinated Compound Biological Sampling in the Vicinity of Morgan, Lawrence, and Limestone Counties, Alabama

IC 217773 under ICR 201401-0923-001 · OMB 0923-0048.

Documents and Forms
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Document Type
Form and Instruction
Form and Instruction
IC Document
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Information Collection (IC) Details

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Perfluorinated Compound Biological Sampling in the Vicinity of Morgan, Lawrence, and Limestone Counties, Alabama 15AUQ
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA PFC Exposure Investigation / Blood and Urine Sampling Questionnaire Decatur EI OMB Package Attachment 4 - Questionnaire 07152015.docx NA No   Paper Only

Health Consumer Health and Safety

09-19-0001 Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances  53 FR 30702

155 0
   
Individuals or Households
 
   0 %

  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 465 0 465 0 0 0
Annual IC Time Burden (Hours) 93 0 93 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Adult Consent Form for Blood and Urine PFC Testing and Questionnaire (>18 years of age) Decatur EI OMB Package Attachment 3A - (Clean).docx 08/05/2015
Adult Consent Form for Storage of Blood Sample for Use in Future Research (> 18 years of age) Decatur EI OMB Package Attachment 3B 07152015.docx 08/05/2015
Children's Assent Form for Blood and Urine PFC Testing and Questionnaire (12 - <18 years of age) Decatur EI OMB Package Attachment 3C 07152015.docx 08/05/2015
Children's Assent Form for Storage of Blood Sample for Use in Future Research (12 - < 18 years of age) Decatur EI OMB Package Attachment 3D 07152015.docx 08/05/2015
Parental Permission Form for Blood and Urine PFC Testing and Questionnaire for Children (12 - < 18 years of age) Participating in Investigation Decatur EI OMB Package Attachment 3E 07152015.docx 08/05/2015
Parental Permission Form for Storage of Blood Sample for Use in Future Research for Children (12 - <18 years of age) Participating in Investigation Decatur EI OMB Package Attachment 3F 07152015.docx 08/05/2015
GenIC Submission Form OMB Comment_Decatur EI OMB Package GenIC Submission Form - 08042015.docx 08/05/2015
Research Determination Decatur EI, OMB Package, Attachment 5 - Research Determination Form.pdf 08/05/2015
Sample Results Letter Decatur EI, OMB Package, Attachment 6 - Draft Letters, 04272015.docx 08/05/2015
Example of Prior Exposure Investigation Final Report Decatur EI, OMB Package, Attachment 7 - Example EI.docx 08/05/2015
IRB Approval of CDC Protocol #6718 Decatur EI, OMB Package, Attachment 8 - CDC IRB Approval #6718.docx 08/05/2015
Supporting Statement A Decatur EI Supporting Statement A - 06AUG2015.docx 08/06/2015
Supporting Statement B Decatur EI Supporting Statement B - 06AUG2015.docx 08/06/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.