 
 
	Form
	Approved OMB
	No. 0923-0041 
	 Exp.
	Date xx/xx/201x
	
 
	CDC
	estimates the average public reporting burden for this collection of
	information as 30 minutes per response, including the time for
	reviewing instructions, searching existing data/information sources,
	gathering and maintaining the data/information needed, and
	completing and reviewing the collection of information. An agency
	may not conduct or sponsor, and a person is not required to respond
	to a collection of information unless it displays a currently valid
	OMB control number. Send comments regarding this burden estimate or
	any other aspect of this collection of information, including
	suggestions for reducing this burden to CDC/ATSDR Information
	Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta,
	Georgia 30333; ATTN: PRA (0923-0041).   
	 
	CDC
	estimates the average public reporting burden for this collection of
	information as 30 minutes per response, including the time for
	reviewing instructions, searching existing data/information sources,
	gathering and maintaining the data/information needed, and
	completing and reviewing the collection of information. An agency
	may not conduct or sponsor, and a person is not required to respond
	to a collection of information unless it displays a currently valid
	OMB control number. Send comments regarding this burden estimate or
	any other aspect of this collection of information, including
	suggestions for reducing this burden to CDC/ATSDR Information
	Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta,
	Georgia 30333; ATTN: PRA (0923-0041).   
	
	
	
 
| File Type | application/msword | 
| Author | adavis | 
| Last Modified By | Kaye, Wendy (ATSDR/DTHHS/EHSB) (CTR) | 
| File Modified | 2016-10-24 | 
| File Created | 2016-10-24 |