Information Collection Request
[ATSDR] Evaluating the Association between Serum Concentrations of Per- and Polyfluoroalkyl Substances (PFAS) and Symptoms and Diagnoses of Selected Acute Viral Illnesses
ICR 202212-0923-001 · OMB 0923-0064 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 0923-22BJ Child 3-6 Symptom Diary |
Form and Instruction | Unchanged | Repair queued |
| Form 0923-22BJ Child 3-6 Follow-up Survey Online |
Form and Instruction | Unchanged | Repair queued |
| Form 0923-22BJ Child 3-6 Follow-up Survey Paper |
Form and Instruction | Unchanged | Repair queued |
| Form 0923-22BJ Child 3-6 Initial Survey |
Form and Instruction | Unchanged | Repair queued |
| Form 0923-22BJ Child 7-17 Symptom Diary |
Form and Instruction | Unchanged | Repair queued |
| Form 0923-0064 Appx D _Child Follow-up Survey REDCap (Online) |
Form and Instruction | Modified | Repair queued |
| Form 0923-0064 Appx D_ Follow-up Child Survey (Word) |
Form and Instruction | Modified | Repair queued |
| Form 0923-0064 Appx B_ Parental Permission, Child Assent, and Initial Survey (paper) – Child 7-17 Initial Survey |
Form and Instruction | Modified | Repair queued |
| Form 0923-22BJ Adult Symptom Diary |
Form and Instruction | Unchanged | Repair queued |
| Form 0923-0064 Appx C_ Adult Follow-up Survey Online |
Form and Instruction | Modified | Repair queued |
| Form 0923-0064 Appx C _Follow-up Adult Survey (Word) |
Form and Instruction | Modified | Repair queued |
| Form 0923-0064 Appx A _Adult Initial Survey & Consent |
Form and Instruction | Modified | Repair queued |
 0923-0064 Change Request Justification 20221208.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2022-12-13 | Repair queued |
| 1 - 2 SSB_PFAS and Viral Infections_20220729.docx |
Supporting Statement B | Uploaded 2022-08-01 | Repair queued |
| 1 - 1 SSA_PFAS Viral Infections_20220729.docx |
Supporting Statement A | Uploaded 2022-08-01 | Repair queued |
| 1 - 3 List of Attachments_20220729.docx |
Supplementary Document | Uploaded 2022-08-01 | Repair queued |
| Protocol_PFAS Viral Infections_20220729.docx |
Supplementary Document | Uploaded 2022-08-01 | Repair queued |
| P_ApndxL_NonResponseMessage_11092021.docx |
Supplementary Document | Uploaded 2022-01-07 | Repair queued |
| P_ApndxK_PrivacyActStmnt_11092021.docx |
Supplementary Document | Uploaded 2022-01-07 | Repair queued |
| P_ApndxJ_ChldAssntCopy.docx |
Supplementary Document | Uploaded 2022-12-14 | Repair queued |
| P_ApndxI_PrntlPrmssnCopy.docx |
Supplementary Document | Uploaded 2022-12-13 | Repair queued |
| P_ApndxH_AdltCnsntCopy.docx |
Supplementary Document | Uploaded 2022-12-13 | Repair queued |
| P_ApndxG2_RcrtmntCmms.docx |
Supplementary Document | Uploaded 2022-12-14 | Repair queued |
| P_ApndxG1_PEATTCoverLttr_20220729.docx |
Supplementary Document | Uploaded 2022-08-01 | Repair queued |
| P_ApndxG_RcrtmntLttr.docx |
Supplementary Document | Uploaded 2022-12-14 | Repair queued |
| P_ApndxF_SmmryImmuneEffcts_06202022.docx |
Supplementary Document | Uploaded 2022-08-01 | Repair queued |
| AttG_DataMngmtPlan_STARS Summary.docx |
Supplementary Document | Uploaded 2022-01-07 | Repair queued |
 AttF_Data Use Agreement Template_01042022.pdf |
Supplementary Document | Uploaded 2022-01-07 | Repair queued |
| AttE_MOP_PFAS Viral Infections_01042022.docx |
Supplementary Document | Uploaded 2022-01-07 | Repair queued |
| 1 - AttD_IRB approval.docx |
Supplementary Document | Uploaded 2022-01-07 | Repair queued |
| AttC_PIA CPO signed.pdf |
Supplementary Document | Uploaded 2022-08-01 | Repair queued |
| 1 - AttB1_60D PblcCmmntsAgncyRespns.docx |
Supplementary Document | Uploaded 2022-01-07 | Repair queued |
| 1 - AttB_60D FRN PFAS Viral Infection.pdf |
Supplementary Document | Uploaded 2022-01-07 | Repair queued |
| 1 - AttA_Authorizing Legislation.docx |
Supplementary Document | Uploaded 2022-01-07 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 251063 |  Child 3-6 Symptom Diary |
Form and Instruction | Unchanged | |
| 251062 | Child 3-6 Follow-up Survey Online |
Form and Instruction | Unchanged | |
| 251061 | Child 3-6 Follow-up Survey Paper |
Form and Instruction | Unchanged | |
| 251060 | Child 3-6 Initial Survey |
Form and Instruction | Unchanged | |
| 251059 | Child 7-17 Symptom Diary |
Form and Instruction | Unchanged | |
| 251058 | Appx D _Child Follow-up Survey REDCap (Online) |
Form and Instruction | Modified | |
| 251057 | Appx D_ Follow-up Child Survey (Word) |
Form and Instruction | Modified | |
| 251056 | Appx B_ Parental Permission, Child Assent, and Initial Survey (paper) – Child 7-17 Initial Survey |
Form and Instruction | Modified | |
| 251055 | Adult Symptom Diary |
Form and Instruction | Unchanged | |
| 251054 | Appx C_ Adult Follow-up Survey Online |
Form and Instruction | Modified | |
| 251053 | Appx C _Follow-up Adult Survey (Word) |
Form and Instruction | Modified | |
| 251052 | Appx A _Adult Initial Survey & Consent |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/TSDR |
| OMB Control No | 0923-0064 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202208-0923-001 |
| Agency Tracking No | 0923-0064-23BK |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |