Identifying Sources of and Risk Factors for Harmful Algal Bloom Exposures through Poison Control Center Follow-up Questionnaires – United States, 2019

Poison Center Collaborations for Public Health Emergencies

OMB: 0920-1166

IC ID: 237171

Information Collection (IC) Details

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Identifying Sources of and Risk Factors for Harmful Algal Bloom Exposures through Poison Control Center Follow-up Questionnaires – United States, 2019 0920-1166-19BMZ
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920-1166 Follow-up questionnaire for individuals calling poison control centers (PCCs) regarding exposures to harmful algal blooms (HABs) – ADULT SUGGESTED REVISION CLEAN Att2 HABs GenIC Questionnaire - Adult.docx NA Yes Yes Fillable Fileable
Form 0920-1166 Follow-up questionnaire for individuals calling poison control centers (PCCs) regarding exposures to harmful algal blooms (HABs) – ADOLESCENT SUGGESTED REVISION CLEAN Att3 HABs GenIC Questionnaire - Adolescent.docx NA Yes Yes Fillable Fileable
Form 0920-1166 Follow-up questionnaire for individuals calling poison control centers (PCCs) regarding exposures to harmful algal blooms (HABs) – PARENT-CHILD SUGGESTED REVISION CLEAN Att4 HABs GenIC Questionnaire - Parent-Child.docx NA Yes Yes Fillable Fileable

Disaster Management Emergency Response

09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems  57 FR 62812

150 0
   
Individuals or Households
 
   100 %

  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 150 0 0 0 0 150
Annual IC Time Burden (Hours) 100 0 0 0 0 100
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
GenIC Request Approval Form 0920-1166 1 - HABs GenIC Rqst Apprvl Form PCCPHE.pdf 07/30/2019
Supporting Statement B 1 - HABS_GenIC_SSB.docx 07/30/2019
Consent - Assent Att1 HABs GenIC Consent and Assent Forms.docx 07/30/2019
Research Determination Form Att5 RDF_HABs GenIC_20190726 signed OS.pdf 07/30/2019
Burden Table Memo Burden Table Memo 0920-1166.msg 07/30/2019
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