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Appx C _Follow-up Adult Survey (Word)

IC 251053 under ICR 202212-0923-001 · OMB 0923-0064.

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Appx C _Follow-up Adult Survey (Word) 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 Evaluating the Association between Serum Concentrations of Per- and Polyfluoroalkyl Substances (PFAS) and Symptoms and Diagnoses of Selected Acute Viral Illnesses Adult (≥ 18 years of age) Follow-up P_ApndxC_F-UAdltSrvy (Word)_20221213.docx Yes 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

350 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

Title Document Date Uploaded
Appx C Fpllow-up Child Survey (REDINE) P_ApndxC_F-UAdltSrvy_REDLINE.pdf 12/05/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.