Child Assent

Per- or Polyfluoroalkyl Substances Exposure Assessments (PFAS EAs)

⚠️ Notice: This information collection may be referencing outdated material.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
Child Assent Form and Instruction
Assent for Minors PrtApndxB4_Assent Form for Minors_20190718_clean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Child Assent	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	none	Assent for Minors	PrtApndxB4_Assent Form for Minors_20190718_clean.docx		Yes	No	Paper Only

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: 199	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	199	199
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	241	241

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.