Exposure Questionnaire for Biological Testing - Parent Proxy

Per- or Polyfluoroalkyl Substances Exposure Assessments (PFAS EAs)

OMB: 0923-0059

IC ID: 233855

Information Collection (IC) Details

View Information Collection (IC)

Exposure Questionnaire for Biological Testing - Parent Proxy
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form NA Exposure Assessment Child PrtApndxF PFAS EAs Adult Child ExpAssmntQstnnre_20190524_clean.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

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

275 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 275 0 0 0 0 275
Annual IC Time Burden (Hours) 69 0 0 0 0 69
Annual IC Cost Burden (Dollars) 1,675 0 0 0 0 1,675

Title Document Date Uploaded
Biological assessment collection log PrtApndxC1_SampleCollectionLog_20200205 clean.docx 02/13/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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