Signed Consent Forms for Medical Exams

Chronic Beryllium Disease Prevention Program

OMB: 1910-5112

IC ID: 45140

Information Collection (IC) Details

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Signed Consent Forms for Medical Exams
 
No Modified
 
Mandatory
 
10 CFR 850

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction DOE F 440-1 Chronic Beryllium Disease Prevention Program Informed Consent 1910-5112 Instrument DOE F 440.1.pdf Yes No Paper Only

Health Illness Prevention

 

5,976 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 5,982 0 0 1,498 0 4,484
Annual IC Time Burden (Hours) 1,496 0 0 375 0 1,121
Annual IC Cost Burden (Dollars) 191,826 0 0 76,083 0 115,743

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