Adult Questionnaire

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: 234695

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Adult Questionnaire
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Adult Questionnaire P_Att18_PeaseAdltQstnnr_20190813 clean.docx Yes Yes Fillable Fileable

Health Health Care Services

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

367 0
   
Individuals or Households
 
   100 %

  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 367 0 367 0 0 0
Annual IC Time Burden (Hours) 184 0 184 0 0 0
Annual IC Cost Burden (Dollars) 4,584 0 4,584 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.

© 2024 OMB.report | Privacy Policy