Form Approved
OMB No. 0923-0059
Exp. Date 06/30/2022
Appendix A1:
ATSDR estimates the average public reporting burden for this collection of information as 5 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0923-0059).
PFAS Exposure Assessment Community Event Evaluation SurveyThank you for attending this event. We would appreciate your feedback.
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Logistics |
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HHS/ATSDR Lockup Graphic
Please continue on the back.
How did you hear about this event? Please check all that apply:
□ Letter □ Email □ Flier □ Facebook/Twitter □ Friend or family member
□ ATSDR website □TV □ Other ___________________________
Was there any information you expected to receive at this event but did not get? Y / N Please explain ___________________________________________________________
Do you understand how individuals are selected for potential participation in the Exposure Assessment? Y / N
Anything else you want to share? ____________________________________________
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Scruton, Karen M. (ATSDR/DCHI/SSB) |
File Modified | 0000-00-00 |
File Created | 2022-06-20 |