ABLES Case Records Form

Blood Lead Surveillance System (BLSS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0931 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0931 ABLES Case Records Form Form and Instruction
Form 0920-0931 ABLES Case Records Form Form and Instruction
0920-0931 ABLES Case Records Form Att6a ABLES Case Rcrds Frm_20210219.xlsx Form and Instruction
0920-0931 ABLES Case Records Form Att6a ABLES Case Rcrds Frm_20210219.xlsx Form and Instruction
Att6a1 ABLES Stnd Var_RTsai_20210219.docx ABLES Standardized Varible Formats IC Document
Att6a1 ABLES Stnd Var_RTsai_20210219.docx ABLES Standardized Varible Formats IC Document

Information Collection (IC) Details

IC Title:	ABLES Case Records Form	Agency IC Tracking Number:	0920-0931

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0931	ABLES Case Records Form	Att6a ABLES Case Rcrds Frm_20210219.xlsx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136 “Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 32	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	32	32
Annual IC Time Burden (Hours)	256	256
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ABLES Standardized Varible Formats	Att6a1 ABLES Stnd Var_RTsai_20210219.docx	03/12/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.