Community Assessment and Engagement Process

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Community Leader Screener	Form	New	Available
Industry Officials in-depth Interview/phone	Form	New	Available
Elected Official in-depth Interview/phone	Form	New	Repair queued
Community Leader in-depth Interview/phone	Form	New	Repair queued
Healthcare Provider Screener	Form	New	Available
Healthcare Provider in-depth Interview/phone	Form	New	Available
Community Member Screener	Form	New	Repair queued
Community Member in-depth Interview/phone	Form	New	Available
Supporting Statement Part B Community Engagement REVISED_6-21-11.doc	Supporting Statement B	Uploaded 2011-07-11	Available
Attachment 3_Recruitment Flyer_2-15-11_FINAL.docx	Supplementary Document	Uploaded 2011-07-11	Repair queued
IRB exemption_6096_.docx	Supplementary Document	Uploaded 2011-07-11	Repair queued
Attachment 2_60 Day FRN_9-27-10.pdf	Supplementary Document	Uploaded 2011-07-11	Repair queued
Attachment 1_Authorizing Legislation CERCLA.docx	Supplementary Document	Uploaded 2011-07-11	Available
Supporting Statement Part A Community Engagement REVISED_6-21-11.doc	Supporting Statement A	Uploaded 2011-07-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
198609	Community Leader Screener	Form	New
198608	Industry Officials in-depth Interview/phone	Form	New
198607	Elected Official in-depth Interview/phone	Form	New
198606	Community Leader in-depth Interview/phone	Form	New
198605	Healthcare Provider Screener	Form	New
198604	Healthcare Provider in-depth Interview/phone	Form	New
198603	Community Member Screener	Form	New
198602	Community Member in-depth Interview/phone	Form	New

ICR Details

OMB Control No:	ICR Reference No: 201107-0923-001
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/TSDR	Agency Tracking No:
Title: Community Assessment and Engagement Process
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 04/02/2012
	Date Received in OIRA: 07/25/2011
Terms of Clearance: Withdrawn per the agency's request.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Communities in proximity to hazardous waste sites are concerned that they are being exposed to hazardous substances being released into the environment. The Agency for Toxic Substances and Disease Registry (ATSDR) requests approval to collect cognitive, social, behavioral, and satisfaction data from community members and stakeholders who may be impacted by exposures to toxic substances.

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Authorizing Statute(s): US Code: 42 USC 103 Name of Law: Comprehensive Environmental Response Compensation, and Liability Act (CERCLA) of 1980
  

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:
	75 FR 59265	09/27/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 41797	07/15/2011
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Community Member in-depth Interview/phone	none	Community Member Interview
Community Member Screener	none	Community Member Screener
Healthcare Provider in-depth Interview/phone	none	Healthcare Provider Interview
Healthcare Provider Screener	none	Healthcare Provider Screener
Community Leader in-depth Interview/phone	none	Community Leader Interview
Elected Official in-depth Interview/phone	none	Elected Official Interview
Industry Officials in-depth Interview/phone	none	Industry Officials Interview
Community Leader Screener	none	Community Leader Screener

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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: No

Burden Reduction Due to:

Short Statement: This is a new data collection request.

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Annual Cost to Federal Government: $151,348

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 07/22/2011

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