[ATSDR] Evaluating the Association between Serum Concentrations of Per- and Polyfluoroalkyl Substances (PFAS) and Symptoms and Diagnoses of Selected Acute Viral Illnesses

ICR 202212-0923-001

OMB: 0923-0064

Federal Form Document

Forms and Documents

Document Name	Status
Form 0923-22BJ Child 3-6 Symptom Diary Form and Instruction	Unchanged
Form 0923-22BJ Child 3-6 Follow-up Survey Online Form and Instruction	Unchanged
Form 0923-22BJ Child 3-6 Follow-up Survey Paper Form and Instruction	Unchanged
Form 0923-22BJ Child 3-6 Initial Survey Form and Instruction	Unchanged
Form 0923-22BJ Child 7-17 Symptom Diary Form and Instruction	Unchanged
Form 0923-0064 Appx D _Child Follow-up Survey REDCap (Online) Form and Instruction	Modified
Form 0923-0064 Appx D_ Follow-up Child Survey (Word) Form and Instruction	Modified
Form 0923-0064 Appx B_ Parental Permission, Child Assent, and Initial Survey (paper) – Child 7-17 Initial Survey Form and Instruction	Modified
Form 0923-22BJ Adult Symptom Diary Form and Instruction	Unchanged
Form 0923-0064 Appx C_ Adult Follow-up Survey Online Form and Instruction	Modified
Form 0923-0064 Appx C _Follow-up Adult Survey (Word) Form and Instruction	Modified
Form 0923-0064 Appx A _Adult Initial Survey & Consent Form and Instruction	Modified
0923-0064 Change Request Justification 20221208.docx Justification for No Material/Nonsubstantive Change	2022-12-13
1 - 2 SSB_PFAS and Viral Infections_20220729.docx Supporting Statement B	2022-08-01
1 - 1 SSA_PFAS Viral Infections_20220729.docx Supporting Statement A	2022-08-01
1 - 3 List of Attachments_20220729.docx Supplementary Document	2022-08-01
Protocol_PFAS Viral Infections_20220729.docx Supplementary Document	2022-08-01
P_ApndxL_NonResponseMessage_11092021.docx Supplementary Document	2022-01-07
P_ApndxK_PrivacyActStmnt_11092021.docx Supplementary Document	2022-01-07
P_ApndxJ_ChldAssntCopy.docx Supplementary Document	2022-12-14
P_ApndxI_PrntlPrmssnCopy.docx Supplementary Document	2022-12-13
P_ApndxH_AdltCnsntCopy.docx Supplementary Document	2022-12-13
P_ApndxG2_RcrtmntCmms.docx Supplementary Document	2022-12-14
P_ApndxG1_PEATTCoverLttr_20220729.docx Supplementary Document	2022-08-01
P_ApndxG_RcrtmntLttr.docx Supplementary Document	2022-12-14
P_ApndxF_SmmryImmuneEffcts_06202022.docx Supplementary Document	2022-08-01
AttG_DataMngmtPlan_STARS Summary.docx Supplementary Document	2022-01-07
AttF_Data Use Agreement Template_01042022.pdf Supplementary Document	2022-01-07
AttE_MOP_PFAS Viral Infections_01042022.docx Supplementary Document	2022-01-07
1 - AttD_IRB approval.docx Supplementary Document	2022-01-07
AttC_PIA CPO signed.pdf Supplementary Document	2022-08-01
1 - AttB1_60D PblcCmmntsAgncyRespns.docx Supplementary Document	2022-01-07
1 - AttB_60D FRN PFAS Viral Infection.pdf Supplementary Document	2022-01-07
1 - AttA_Authorizing Legislation.docx Supplementary Document	2022-01-07

IC Document Collections

IC ID	Document Title	Status
251063	Child 3-6 Symptom Diary Form and Instruction	Unchanged
251062	Child 3-6 Follow-up Survey Online Form and Instruction	Unchanged
251061	Child 3-6 Follow-up Survey Paper Form and Instruction	Unchanged
251060	Child 3-6 Initial Survey Form and Instruction	Unchanged
251059	Child 7-17 Symptom Diary Form and Instruction	Unchanged
251058	Appx D _Child Follow-up Survey REDCap (Online) Form and Instruction	Modified
251057	Appx D_ Follow-up Child Survey (Word) Form and Instruction	Modified
251056	Appx B_ Parental Permission, Child Assent, and Initial Survey (paper) – Child 7-17 Initial Survey Form and Instruction	Modified
251055	Adult Symptom Diary Form and Instruction	Unchanged
251054	Appx C_ Adult Follow-up Survey Online Form and Instruction	Modified
251053	Appx C _Follow-up Adult Survey (Word) Form and Instruction	Modified
251052	Appx A _Adult Initial Survey & Consent Form and Instruction	Modified