Child Questionnaire - Long Form

Human Health Effects of Drinking Water Exposures to Per- and Polyfluoroalkyl Substances (PFAS): A Multi-site Cross-sectional Study

OMB: 0923-0063

IC ID: 239058

Documents and Forms
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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 and Instruction none Child questionnaire - long form M_Att15_ ChldQstnnr_LongForm_20200714__clean.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

SORN 09–19–0001, ‘‘Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances"  76 FR 4432

560 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 560 0 0 0 0 560
Annual IC Time Burden (Hours) 280 0 0 0 0 280
Annual IC Cost Burden (Dollars) 6,994 0 0 0 0 6,994

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