Evaluation of Efficacy of Household Water Filtration/Treatment Devices in Households with Private Wells

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form None assigned Evaluation of Efficacy of Household Water Filtration/Treatment Devices in Households with Private Wells - Screening Questionnaire	Form and Instruction	Modified	Available
Form None assigned Evaluation of Efficacy of Household Water Filtration/Treatment Devices in Households with Private Wells - Household Survey Questionnaire	Form and Instruction	New	Available
0920-0670 - 30 Day FRN published 12-5-2006.htm	Supplementary Document	Uploaded 2006-12-05	Available
Attach 2 60-day FRN.pdf	Supplementary Document	Uploaded 2006-11-29	Available
0920-0670 SS (11-29-2006) final.doc	Supporting Statement A	Uploaded 2006-11-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7138	Evaluation of Efficacy of Household Water Filtration/Treatment Devices in Households with Private Wells - Screening Questionnaire	Form and Instruction	Modified
46582	Evaluation of Efficacy of Household Water Filtration/Treatment Devices in Households with Private Wells - Household Survey Questionnaire	Form and Instruction	New

ICR Details

OMB Control No: 0920-0670	ICR Reference No: 200612-0920-011
Status: Historical Active	Previous ICR Reference No: 200410-0920-005
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluation of Efficacy of Household Water Filtration/Treatment Devices in Households with Private Wells
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/29/2007
	Date Received in OIRA: 12/29/2006
Terms of Clearance: Approved consistent with the existing terms of clearance: CDC may share geo-reference data collected under this project with EPA and USGS provided that the agency obtains written consent in advance from respondents for such purposes. Any data shared shall include a discussion of the study design and its limitations, and all data must be used in a manner consistent with each agencies respective data quality guidelines.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2008	12 Months From Approved	03/31/2007
Responses	1,800	0	1,800
Time Burden (Hours)	300	0	300
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this study is to evaluate how water treatment device efficacy is impacted by behaviors such as maintenance and selection of appropriate technologies. Working with public health authorities in Colorado, Maine, Missouri, Nebraska, North Carolina and Wisconsin, we plan to recruit 600 households to participate in a study to determine whether people using water treatment devices are protected from exposure to contaminants that may be found in their well water. We plan to recruit households that own private wells and use filtration/treatment devices to treat their tap water.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act - Research and Investigations Generally
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 9134	02/22/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 70517	12/05/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Evaluation of Efficacy of Household Water Filtration/Treatment Devices in Households with Private Wells - Screening Questionnaire	None assigned	Attach 4_Participant Screening Questionnaire
Evaluation of Efficacy of Household Water Filtration/Treatment Devices in Households with Private Wells - Household Survey Questionnaire	None assigned	Attach 5_Scheduling Form AND Attach 6_Questionnaire: HWFS

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,800	1,800	0	0	0	0
Annual Time Burden (Hours)	300	300	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The purpose of this study is to collect data, through water sampling and quesionnaries, to determine if people in households on private wells are being exposed to contaminants of health concern. Specifically, we are interested in how factors such as selection, installation, maintenance and use of treatment devises impact the efficacy of these devices. Due to a one year delay in obtaining funding for the project and delays in synchronizing the study protocol for Institutional Review Boards at CDC and in four of the six study states, we were unable to complete this study during the original OMB approval period and request an additional one year to complete the project.

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Annual Cost to Federal Government: $57,800

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/19/2006

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