Information Collection Request

Biomonitoring of Great Lakes Populations Program

ICR 201210-0923-001 · OMB 0923-0044 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
MI Contact Information Sheet Form New Available
NY - Network Questions - Burmese Form Modified Available
NY Interview - Burmese Form Modified Repair queued
NY Consent - Burmese Form Modified Available
NY Screener - Burmese Form Modified Available
NY Questionnaire Form Modified Available
NY Consent Form Modified Available
NY Responder Script Form Modified Available
NY Nonresponder Script Form Modified Available
NY Online Screener Form Modified Available
NY Mail-in Screener Form Modified Available
MN Participation Record Form Modified Available
MN Clinic Visit Form Form Modified Repair queued
MN Participant Questionnaire Form Modified Available
MN Contact Information Form Modified Available
MN Consent Form Modified Available
MN Refusal Questions Form Modified Available
MN Recruitment Script Form Modified Available
MI Biomonitoring Questionnaire Form Modified Available
MI Informed Consent Form Modified Available
MI Scheduling Questionnaire Form Modified Available
MI Screener Form Modified Available
Att7c_CLIA_Certs_20120531.docx Supplementary Document Uploaded 2012-10-04 Available
3-GreatLakes_SSB_20120712.doc Supporting Statement B Uploaded 2012-09-27 Available
Att10c2_metals_results_letter (Burmese Translation).pdf Supplementary Document Uploaded 2012-10-01 Available
Att10c1_chem_results_letter (Burmese Translation).pdf Supplementary Document Uploaded 2012-10-01 Available
Att7d_Lab_Contact_Info.docx Supplementary Document Uploaded 2012-10-01 Available
Att7b_Prgm_QAQC_Proc_20120927_clean.docx Supplementary Document Uploaded 2012-10-01 Available
Att7a_ChemAnalytes 20120927_clean.docx Supplementary Document Uploaded 2012-10-01 Available
2-GreatLakes_SSA_ListAtt_20120927_clean.docx Supplementary Document Uploaded 2012-10-01 Available
Att10c_NY_Results_Commun 20120619.docx Supplementary Document Uploaded 2012-09-27 Available
Att10b_MN_Results_Commun_20120619.doc Supplementary Document Uploaded 2012-09-27 Available
Att10a_MI_Results_Commun_20120712.doc Supplementary Document Uploaded 2012-09-27 Available
Att10_Results_Commun_20120723.docx Supplementary Document Uploaded 2012-09-27 Available
Att9_Non-research_20120131.docx Supplementary Document Uploaded 2012-09-27 Available
Att8_Outside_Consults_20120131.docx Supplementary Document Uploaded 2012-09-27 Available
Att6_NY_ICFlow 20120619.docx Supplementary Document Uploaded 2012-09-27 Available
Att4_MI_ICFlow 20120619.docx Supplementary Document Uploaded 2012-09-27 Available
Att5_MN_ICFlow 20120619.docx Supplementary Document Uploaded 2012-09-27 Available
Att3b_Prgrm_Smmry_Flw_Chrt_20120619.docx Supplementary Document Uploaded 2012-09-27 Available
Att3a_State_Cprtv_Agrmnt_Prtnrs_20120619.docx Supplementary Document Uploaded 2012-09-27 Available
Att2_60dyFRN_20111104.pdf Supplementary Document Uploaded 2012-09-27 Available
Att1_AuthLegsl_20120131.docx Supplementary Document Uploaded 2012-09-27 Available
2-GreatLakes_SSA_Refs_20120619.docx Supplementary Document Uploaded 2012-09-27 Available
Att6a_NY_FctSht_LA_20120619.docx Supplementary Document Uploaded 2012-09-27 Available
Att4a1._MI_Dtrt_AOC_Brochure_20120712.pdf Supplementary Document Uploaded 2012-09-27 Available
2-GreatLakes_SSA_20120927_clean.docx Supporting Statement A Uploaded 2012-10-01 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
204369 MI Contact Information Sheet Form New
201475 NY - Network Questions - Burmese Form Modified
201474 NY Interview - Burmese Form Modified
201473 NY Consent - Burmese Form Modified
201472 NY Screener - Burmese Form Modified
201471 NY Questionnaire Form Modified
201470 NY Consent Form Modified
201469 NY Responder Script Form Modified
201468 NY Nonresponder Script Form Modified
201467 NY Online Screener Form Modified
201466 NY Mail-in Screener Form Modified
201465 MN Participation Record Form Modified
201464 MN Clinic Visit Form Form Modified
201463 MN Participant Questionnaire Form Modified
201462 MN Contact Information Form Modified
201461 MN Consent Form Modified
201460 MN Refusal Questions Form Modified
201459 MN Recruitment Script Form Modified
201458 MI Biomonitoring Questionnaire Form Modified
201457 MI Informed Consent Form Modified
201456 MI Scheduling Questionnaire Form Modified
201455 MI Screener Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
10/31/2015 36 Months From Approved
7,664 0 0
938 0 0
0 0 0





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 7,664 0 0 7,664 0 0
Annual Time Burden (Hours) 938 0 0 938 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No