Medical Record Abstraction - Adult

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

OMB: 0923-0063

IC ID: 239066

Information Collection (IC) Details

View Information Collection (IC)

Medical Record Abstraction - Adult
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Multi-site Study Medical Record Abstraction Form - Adult M_Att17a_MedRecAbstrctnForm_Adult_20191212.docx No   Paper Only

Health Public Health Monitoring

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

150 0
   
Private Sector Businesses or other for-profits
 
   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 2,400 0 0 0 0 2,400
Annual IC Time Burden (Hours) 800 0 0 0 0 800
Annual IC Cost Burden (Dollars) 16,927 0 0 0 0 16,927

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