OMB control number

[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 · HHS/TSDR.

OMB 0923-0064

Latest Forms, Documents, and Supporting Material

Document Name
Form 0923-22BJ Child 3-6 Symptom Diary Form and Instruction
Form 0923-22BJ Child 3-6 Follow-up Survey Online Form and Instruction
Form 0923-22BJ Child 3-6 Follow-up Survey Paper Form and Instruction
Form 0923-22BJ Child 3-6 Initial Survey Form and Instruction
Form 0923-22BJ Child 7-17 Symptom Diary Form and Instruction
Form 0923-0064 Appx D _Child Follow-up Survey REDCap (Online) Form and Instruction
Form 0923-0064 Appx D_ Follow-up Child Survey (Word) Form and Instruction
Form 0923-0064 Appx B_ Parental Permission, Child Assent, and Initial Survey (paper) – Child 7-17 Initial Survey Form and Instruction
Form 0923-22BJ Adult Symptom Diary Form and Instruction
Form 0923-0064 Appx C_ Adult Follow-up Survey Online Form and Instruction
Form 0923-0064 Appx C _Follow-up Adult Survey (Word) Form and Instruction
Form 0923-0064 Appx A _Adult Initial Survey & Consent Form and Instruction
0923-0064 Change Request Justification 20221208.docx Justification for No Material/Nonsubstantive Change
1 - 2 SSB_PFAS and Viral Infections_20220729.docx (document unavailable) Supporting Statement B
1 - 1 SSA_PFAS Viral Infections_20220729.docx (document unavailable) Supporting Statement A
1 - 3 List of Attachments_20220729.docx (document unavailable) Supplementary Document
Protocol_PFAS Viral Infections_20220729.docx (document unavailable) Supplementary Document
P_ApndxL_NonResponseMessage_11092021.docx Supplementary Document
P_ApndxK_PrivacyActStmnt_11092021.docx (document unavailable) Supplementary Document
P_ApndxJ_ChldAssntCopy.docx (document unavailable) Supplementary Document
P_ApndxI_PrntlPrmssnCopy.docx Supplementary Document
P_ApndxH_AdltCnsntCopy.docx Supplementary Document
P_ApndxG2_RcrtmntCmms.docx (document unavailable) Supplementary Document
P_ApndxG1_PEATTCoverLttr_20220729.docx (document unavailable) Supplementary Document
P_ApndxG_RcrtmntLttr.docx (document unavailable) Supplementary Document
P_ApndxF_SmmryImmuneEffcts_06202022.docx Supplementary Document
AttG_DataMngmtPlan_STARS Summary.docx Supplementary Document
AttF_Data Use Agreement Template_01042022.pdf Supplementary Document
AttE_MOP_PFAS Viral Infections_01042022.docx Supplementary Document
1 - AttD_IRB approval.docx (document unavailable) Supplementary Document
AttC_PIA CPO signed.pdf (document unavailable) Supplementary Document
1 - AttB1_60D PblcCmmntsAgncyRespns.docx (document unavailable) Supplementary Document
1 - AttB_60D FRN PFAS Viral Infection.pdf (document unavailable) Supplementary Document
1 - AttA_Authorizing Legislation.docx Supplementary Document
Child 3-6 Symptom Diary Form and Instruction
Child 3-6 Follow-up Survey Online Form and Instruction
Child 3-6 Follow-up Survey Paper Form and Instruction
Child 3-6 Initial Survey Form and Instruction
Child 7-17 Symptom Diary Form and Instruction
Appx D _Child Follow-up Survey REDCap (Online) Form and Instruction
Appx D_ Follow-up Child Survey (Word) Form and Instruction
Appx B_ Parental Permission, Child Assent, and Initial Survey (paper) – Child 7-17 Initial Survey Form and Instruction
Adult Symptom Diary Form and Instruction
Appx C_ Adult Follow-up Survey Online Form and Instruction
Appx C _Follow-up Adult Survey (Word) Form and Instruction
Appx A _Adult Initial Survey & Consent Form and Instruction

All Historical Document Collections

202212-0923-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2022-12-15
202208-0923-001 Approved with change	New collection (Request for a new OMB Control Number)	2022-08-02