Adult Exposure Assessment Questionnaire

Per- or Polyfluoroalkyl Substances Exposure Assessments (PFAS EAs)

OMB: 0923-0059

IC ID: 233852

Information Collection (IC) Details

View Information Collection (IC)

Adult Exposure Assessment Questionnaire
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Adult-Child Exposure Assessment Questionnaire PrtApndxF1_PFAS EAs Adult Child ExpAssmntQstnnre_20200205 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

1,501 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 1,501 0 0 0 0 1,501
Annual IC Time Burden (Hours) 751 0 0 0 0 751
Annual IC Cost Burden (Dollars) 18,267 0 0 0 0 18,267

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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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