ABLES Case Records Form and Brief Narrative Report

Childhood Blood Lead Surveillance (CBLS) and Adult Blood Lead Epidemiology and Surveillance (ABLES)

Documents and Forms

Document Name Document Type
ABLES Case Records Form and Brief Narrative Report Form and Instruction
Att5c1 ABLES Case Records Format_20171006.docx Instruction
Adult Blood Lead Epidemiology and Surveillance (ABLES) C Att5c ABLES Case Records Form and Brf Narrative Rpt.xlsx Form and Instruction

Information Collection (IC) Details

IC Title:	ABLES Case Records Form and Brief Narrative Report	Agency IC Tracking Number:

Is this a Common Form? No		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	NA	Adult Blood Lead Epidemiology and Surveillance (ABLES) Case Records Form and Brief Narrative Report	Att5c ABLES Case Records Form and Brf Narrative Rpt.xlsx	NA	Yes	Yes	Fillable Fileable
Instruction			Att5c1 ABLES Case Records Format_20171006.docx	NA	Yes	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136 “Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 32	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	32	32
Annual IC Time Burden (Hours)	256	256
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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