Appx C_ Adult Follow-up Survey Online

[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: 251054

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Appx C_ Adult Follow-up Survey Online 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_ApndxC1_F-UAdltSrvy_REDCap.pdf Yes Yes 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

1,050 0
   
Individuals or Households
 
   100 %

  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 4,200 0 0 0 0 4,200
Annual IC Time Burden (Hours) 1,750 0 0 0 0 1,750
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Follow-up AdultSurvey (Word) P_ApndxC_F-UAdltSrvy (Word)_20221213.docx 12/14/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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