Assessment of Potential Exposure from Private Wells for Drinking Water

There is no comprehensive knowledge about the locations of private wells, the populations served by these sources, potential contaminants that might be present in private well water in specific areas of the country, or the potential health risks associated with drinking water from these sources. The goal of this generic clearance information collection request (Generic ICR) is to expedite investigations of private well water for drinking in response to specific investigation requests. Each investigation will assess exposure to contaminants in drinking water from private wells in a geographic area specified by the requesting entity. Requesting entities may be any state, territorial, local, or tribal health department in the United States. Methods to collect data include questionnaires and analysis of clinical specimens and/or environmental samples.

The latest form for Assessment of Potential Exposure from Private Wells for Drinking Water expires 2024-01-31 and can be found here.