Appx A _Adult Initial Survey & Consent

[ATSDR] Evaluating the Association between Serum Concentrations of Per- and Polyfluoroalkyl Substances (PFAS) and Symptoms and Diagnoses of Selected Acute Viral Illnesses

OMB: 0923-0064

IC ID: 251052

Information Collection (IC) Details

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Appx A _Adult Initial Survey & Consent 0923-0064-23BK
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0923-0064 Consent to Take Part in a Research Study and Initial Survey (Adult ≥ 18 years of age) P_ApndxA_InAdltSrvyCnsnt.docx No   Fillable Fileable

Health Public Health Monitoring

Records of Persons Exposed or Potentially Exposed to Hazardous or Toxic Substances (retrievable by name or SSN)  76 FR 4431

1,400 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 1,400 0 0 0 0 1,400
Annual IC Time Burden (Hours) 700 0 0 0 0 700
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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