Medical Record Abstraction - Adult

Human Health Effects of Drinking Water Exposures to Per- and Polyfluoroalkyl Substances (PFAS) at Pease International Tradeport, Portsmouth, NH (The Pease Study)

OMB: 0923-0061

IC ID: 234701

Information Collection (IC) Details

View Information Collection (IC)

Medical Record Abstraction - Adult
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Medical Record Abstraction - Adult P_Att19a_MedRecAbstrctnForm_Adult_20180802.docx Yes No Paper Only

Health Public Health Monitoring

Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances  76 FR 4432

25 0
   
Individuals or Households
 
   0 %

  Requested 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 375 0 375 0 0 0
Annual IC Time Burden (Hours) 125 0 125 0 0 0
Annual IC Cost Burden (Dollars) 2,573 0 2,573 0 0 0

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.

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