Biomonitoring of Great Lakes Populations Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
NY Burmese Network Questions	Form	New	Available
NY Burmese Questionnaire	Form	New	Available
NY Burmese Consent	Form	New	Available
New York Burmese Screener	Form	New	Available
New York Questionnaire	Form	New	Available
New York Consent	Form	New	Available
New York Responder Script	Form	New	Available
New York Non-responder Script	Form	New	Available
New York On-line Screener	Form	New	Available
New York Mail-in Screener	Form	New	Available
Minnesota Participation Record	Form	New	Available
Minnesota Clinic Visit	Form	New	Available
Minnesota Participant Questionnaire	Form	New	Available
Minnesota Contact Information	Form	New	Available
Minnesota Consent	Form	New	Available
Minnesota Refusal Questions	Form	New	Available
Minnesota Recruitment Script	Form	New	Available
Michigan Biomonitoring Questionnaire	Form	New	Available
Michigan Consent	Form	New	Available
Michigan Scheduling Questionnaire	Form	New	Available
Michigan screening questionnaire	Form	New	Available
Great Lakes_SS_B_2.15.2012.doc	Supporting Statement B	Uploaded 2012-02-23	Repair queued
2-GreatLakes_SSA_Refs.docx	Supplementary Document	Uploaded 2012-02-27	Available
Att9 Non-research.docx	Supplementary Document	Uploaded 2012-02-23	Available
Att8_Outside_Consults.docx	Supplementary Document	Uploaded 2012-02-23	Available
Att7_ChemAnalytes.docx	Supplementary Document	Uploaded 2012-02-23	Available
Att3_StudyAreas.docx	Supplementary Document	Uploaded 2012-02-23	Available
Att1_AuthLegsl.docx	Supplementary Document	Uploaded 2012-02-23	Available
Att6_NY_ICFlow.docx	Supplementary Document	Uploaded 2012-02-27	Available
Att5_MN_ICFlow.docx	Supplementary Document	Uploaded 2012-02-27	Available
Att4_MI_ICFlow.docx	Supplementary Document	Uploaded 2012-02-27	Repair queued
GreatLakes_SuppStmt_A_2.22.12.docx	Supporting Statement A	Uploaded 2012-02-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
201475	NY Burmese Network Questions	Form	New	NY Burmese Network Questions
201474	NY Burmese Questionnaire	Form	New	NY Burmese Questionnaire
201473	NY Burmese Consent	Form	New	NY Burmese Consent
201472	NY Burmese Screener	Form	New	New York Burmese Screener
201471	New York Questionnaire	Form	New	New York Questionnaire
201470	New York Consent	Form	New	New York Consent
201469	New York Responder Script	Form	New	New York Responder Script
201468	New York Non-responder Script	Form	New	New York Non-responder Script
201467	New York On-line Screener	Form	New	New York On-line Screener
201466	New York Mail-in Screener	Form	New	New York Mail-in Screener
201465	Minnesota Participation Record	Form	New	Minnesota Participation Record
201464	Minnesota Clinic Visit	Form	New	Minnesota Clinic Visit
201463	Minnesota Participant Questionnaire	Form	New	Minnesota Participant Questionnaire
201462	Minnesota Contact Information	Form	New	Minnesota Contact Information
201461	Minnesota Consent	Form	New	Minnesota Consent
201460	Minnesota Refusal Questions	Form	New	Minnesota Refusal Questions
201459	Minnesota Recruitment Script	Form	New	Minnesota Recruitment Script
201458	Michigan Biomonitoring Questionnaire	Form	New	Michigan Biomonitoring Questionnaire
201457	Michigan Consent	Form	New	Michigan Consent
201456	Michigan Scheduling Questionnaire	Form	New	Michigan Scheduling Questionnaire
201455	Michigan Screener	Form	New	Michigan screening questionnaire

ICR Details

OMB Control No: 0923-0044	ICR Reference No: 201203-0923-001
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/TSDR	Agency Tracking No:
Title: Biomonitoring of Great Lakes Populations Program
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: 09/26/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/07/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		24 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The FY 2010-14 Great Lakes Restoration Initiative (GLRI) was established to protect, restore, and maintain the Great Lakes ecosystem by a task force of 16 federal agencies led by the EPA and over $750,000 was appropriated. ATSDR's Great Lakes Biomonitoring Program provides assessment of human exposure to contaminants concurrent with GLRI activities. ATSDR awarded fund to 3 state health departments to study exposures in their jurisdictions.

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Authorizing Statute(s): US Code: 42 USC 9604 Name of Law: CERCLA
   US Code: 42 USC 9626 Name of Law: Superfund Amendments and Reauthorization Act of 1986
   PL: Pub.L. 111 - 88 1 Name of Law: Dept. of Interior, Environment, and Related Agencies Appropriations Act of 2010
  

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:
	76 FR 68462	11/04/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 12594	03/01/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 21

table that charts list of burden

IC Title	Form No.	Form Name
Michigan Biomonitoring Questionnaire	none	Michigan Biomonitoring Questionnaire
Michigan Consent	none	Michigan Consent
Michigan Scheduling Questionnaire	none	Michigan Scheduling Questionnaire
Michigan Screener	none	Michigan screening questionnaire
Minnesota Clinic Visit	none	Minnesota Clinic Visit
Minnesota Consent	none	Minnesota Consent
Minnesota Contact Information	none	Minnesota Contact Information
Minnesota Participant Questionnaire	none	Minnesota Participant Questionnaire
Minnesota Participation Record	none	Minnesota Participation Record
Minnesota Recruitment Script	none	Minnesota Recruitment Script
Minnesota Refusal Questions	none	Minnesota Refusal Questions
NY Burmese Consent	none	NY Burmese Consent
NY Burmese Network Questions	none	NY Burmese Network Questions
NY Burmese Questionnaire	none	NY Burmese Questionnaire
NY Burmese Screener	none	New York Burmese Screener
New York Consent	none	New York Consent
New York Mail-in Screener	none	New York Mail-in Screener
New York Non-responder Script	none	New York Non-responder Script
New York On-line Screener	none	New York On-line Screener
New York Questionnaire	none	New York Questionnaire
New York Responder Script	none	New York Responder Script

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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 ICR.

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Annual Cost to Federal Government: $3,800,000

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? Yes

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: 03/07/2012

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