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Federal forms, ICRs, and supporting documents

Information Collection

Exposure to Arsenic and Uranium in Private Well Water in Connecticut New Mexico and New Hampshire

IC 236443 under ICR 201606-0920-007 · OMB 0920-0974.

Documents and Forms
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Instruction
Form
Form and Instruction
Form
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Information Collection (IC) Details

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Exposure to Arsenic and Uranium in Private Well Water in Connecticut New Mexico and New Hampshire 0920-1173-19BGI
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920-1173 Screening Survey AttC_Screening Survey.docx No   Fillable Fileable
Form and Instruction 0920-1173 Food and Bathing Log AttE_FoodandBathing Log.docx No   Fillable Fileable
Instruction AttF_Urine Collection Directions.docx No   Paper Only
Form 0920-1173 Survey (Exposure to Arsenic an Uranium in Private Well Water in Connecticut, New Mexico, and New Hampshire AttG_Survey.docx No   Fillable Fileable

Health Illness Prevention

 

300 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 1,200 0 1,200 0 0 0
Annual IC Time Burden (Hours) 150 0 150 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA SSA_Exposure to Arsenic and Uranium in Private Well Water.docx 06/12/2019
SSB SSB_Exposure to Arsenic and Uranium in Private Well Water.docx 06/12/2019
Att A_Letters of Collaborations AttA_Letters of Collaboration.pdf 06/12/2019
Att B_Invitation Letter AttB_Invitation Letter.docx 06/12/2019
Att D_Consent Form AttD_Consent Form.docx 06/12/2019
Att H_Participant Result Letter AttH_Participant Results Letter.docx 06/12/2019
Att I_Research Determination Form AttI_Research Determination Form.pdf 06/12/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.