Request for Child School Record Abstraction

[ATSDR] Human Health Effects of Drinking Water Exposures to Per- and Polyfluoroalkyl Substances (PFAS): A Multi-site Cross-sectional Study

Documents and Forms

Document Name Document Type
M_Att18b_RequestChildSchlRecAbstrctn_20191212_updt.docx Other-Letter of Request to School Ad
M_Att18b_RequestChildSchlRecAbstrctn_20191212_updt.docx Other-Letter of Request to School Ad

Information Collection (IC) Details

IC Title:	Request for Child School Record Abstraction	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Letter of Request to School Administrator with Study Information			M_Att18b_RequestChildSchlRecAbstrctn_20191212_updt.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: SORN 09–19–0001, ‘‘Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances"	FR Citation: 76 FR 4432

Number of Respondents: 30	Number of Respondents for Small Entity: 30

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	690	690
Annual IC Time Burden (Hours)	230	230
Annual IC Cost Burden (Dollars)	10,730	10,730

Documents for IC

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.