Child Questionnaire - Long Form

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: 234696

Information Collection (IC) Details

View Information Collection (IC)

Child Questionnaire - Long Form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Child Questionnaire - Long Form P_Att17_PeaseChildQstnnr LongForm 20190813 clean.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

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

140 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 140 0 140 0 0 0
Annual IC Time Burden (Hours) 70 0 70 0 0 0
Annual IC Cost Burden (Dollars) 1,749 0 1,749 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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