Information Collection

Household Recruitment Script for Environmental Sampling

IC 233859 under ICR 202206-0923-001 · OMB 0923-0059.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Household Recruitment Script for Environmental Sampling	Form and Instruction
Household Recruitment Script for Environmental Sampling PrtApndxA4_HHRecrtScrptEnvSampling_20220609.docx	Form and Instruction
Household Recruitment Script for Environmental Sampling PrtApndxA4_HHRecrtScrptEnvSampling_20220609.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Household Recruitment Script for Environmental Sampling	PrtApndxA4_HHRecrtScrptEnvSampling_20220609.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances

FR Citation: 76 FR 4432

Number of Respondents: 70

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	70	-47	117
Annual IC Time Burden (Hours)	6	-4	10
Annual IC Cost Burden (Dollars)	168	-70	238

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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