Blood Draw and Urine Collection Form

Human Health Effects of Drinking Water Exposures to Per- and Polyfluoroalkyl Substances (PFAS) at Pease International Tradeport, Portsmouth, NH (The Pease Study)

OMB: 0923-0061

IC ID: 234694

Information Collection (IC) Details

View Information Collection (IC)

Blood Draw and Urine Collection Form
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Blood Draw and Urine Collection P_Att16_BloodDrawUrineCollectionForm_20180802.docx Yes No Paper Only

Health Public Health Monitoring

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

542 0
   
Individuals or Households
 
   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 542 0 0 0 0 542
Annual IC Time Burden (Hours) 90 0 0 0 0 90
Annual IC Cost Burden (Dollars) 2,256 0 0 0 0 2,256

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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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