Information Collection

Household Recruitment Script for Environmental Sampling

IC 233859 under ICR 201811-0923-001 · OMB 0923-0059.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0059 can be found here:

Documents and Forms

Document Name Document Type
Household Recruitment Script for Environmental Sampling Form
Household Recruitment Script for Environmental Sampling PrtApndxA4_HHRecrtScrptEnvSampling 20190206_clean.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Household Recruitment Script for Environmental Sampling	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	NA	Household Recruitment Script for Environmental Sampling	PrtApndxA4_HHRecrtScrptEnvSampling 20190206_clean.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances	FR Citation: 76 FR 4432

Number of Respondents: 117	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	117	117
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	238	238

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.