Adult Consent

Per- or Polyfluoroalkyl Substances Exposure Assessments (PFAS EAs)

OMB: 0923-0059

IC ID: 233851

Information Collection (IC) Details

View Information Collection (IC)

Adult Consent
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form NA Adult Consent PrtApndxB2_Adult Consent Form_20190206_clean.docx NA Yes No Fillable Fileable Signable

Health Public Health Monitoring

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

1,501 0
   
Individuals or Households
 
   0 %

  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 1,501 0 0 0 0 1,501
Annual IC Time Burden (Hours) 250 0 0 0 0 250
Annual IC Cost Burden (Dollars) 6,079 0 0 0 0 6,079

Title Document Date Uploaded
Privacy Act Statement PrtApndxB1_PrivacyActStatement 20181012.docx 11/01/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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