Get the free YOU MUST COMPLETE & RETURN AT LEAST PART 1 OF THIS SURVEY - state nj

PLEASE NOTE: YOU MUST COMPLETE & RETURN AT LEAST PART 1 OF THIS SURVEY CHEMICAL INVENTORY PAGE (PART 2) IS LAST PAGE OF BOOKLET (FACING INSIDE BACK COVER) NOTE: Unstaffed sites (cell towers etc.)

For additional information, refer to the following pages: Survey Submission Information; and CRT Survey Data Submission. 2. (U) As required, add to the survey for unreported sites in Box B of the unstaffed site. Send a letter to the Department listing locations of unreported substations. 3. (U) Complete and return the remaining form pages. 4. (U) Include all requested material on the form forms (Forms 1 and 4). Complete all entries/sections in the order in which submitted. 5. (U) Include a photocopy of the Form 1, along with the completed Survey Questionnaire and appropriate comments. 6. (U) Mail to: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 2201 CUMBERLAND STREET, WASHINGTON, DC 20 7. (U) Information is not available in electronic format 8. (U) Fax to 9. (U) If requesting the name, address, and phone number of a person in the HHS field office responsible for responding, please provide the information at the time of your request. 11. (U) The CRT survey can be completed on any workday from 10:00 A.M. to 2:30 P.M. Please note: If additional telephone contact is required by the requesting agency, please note that information is not available in electronic format 12. (U) Fax: and send all other relevant information to: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES PATIENT SAFETY DATA SHEET 1120 P ST NE OLD CANYON, DC 20513 13. (U) Information is not available in electronic format 14. (U) Fax: 15. (U) If the name and address of the person in the HHS field office responsible for responding is not known, send the information via telephone and request that the HHS field office contact the Agency requesting information by telephone. 16. (U) If submitting the CRT survey, you must: (1) Send a copy to: U.S.

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