Blood Lead and Urine Arsenic Levels in Anaconda, MT - Exposure Investigation: Anaconda EI II

ATSDR Exposure Investigations (EIs)

OMB: 0923-0048

IC ID: 233661

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

View Information Collection (IC)

Blood Lead and Urine Arsenic Levels in Anaconda, MT - Exposure Investigation: Anaconda EI II 0923-0048-19BV
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0923-0048 Anaconda MT Exposure Investigation II - Participant Questionnaire and Sample Collection Att4_Questionnaire_ Anaconda EI II - 0923-0048 OS.docx NA Yes Yes Fillable Fileable

Health Consumer Health and Safety

09-19-0001 - Records of Persons Exposed or Potentially Exposed to Hazardous or Toxic Substances  59 FR 67085

300 0
   
Individuals or Households
 
   100 %

  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 300 0 300 0 0 0
Annual IC Time Burden (Hours) 150 0 150 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
0923-0048 GenIC Submission Form Anaconda_EI_II_GenIC SubmissionForm.docx 10/22/2018
Privacy Act Statement Att3A_Privacy Act Statement_Anaconda EI_II 0923-0048.docx 10/22/2018
Adult Consent Form Att3B_Adult Consent Form_Anaconda EI_II_0923-0048.docx 10/22/2018
Parental Permission Form - Children under 18 Years of Age Att3C_Parental Permission Form_Anaconda EI_II_0923-0048.docx 10/22/2018
Child Assent Form - Children between 7-17 Years of Age Att3D_Child Assent Form_Anaconda EI II - 0923-0048.docx 10/22/2018
Human Subjects Research Determination Form Att5__Anaconda EI II RDF signed OS.pdf 10/22/2018
Example Results Letter Att6_Example REsults Letter_Anaconda MT EI II - 0923-0048.docx 10/22/2018
Exposure Investigation Report (Example: FORMER UNITED ZINC & ASSOCIATED SMELTERS - Iola, Kansas) Att7_EI Report Example_Former United Zinc EI (final) _ 08-15-2018.pdf 10/22/2018
Privacy Impact Assessment Att8_PIA_Requests_Anaconda EI II_0923-0048.pdf 10/22/2018
Exposure Investigation Protocol Att9 Anaconda EI II Protocol_final 0923-0048.docx 10/22/2018
Supporting Statement A Att1_Anaconda MT EI II SupStatement A - 0923-0048.docx 10/22/2018
Supporting Statement B Att2_Anaconda MT EI II SupStatement B - 0923-0048.docx 10/22/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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