Information Collection Request

Biomonitoring of Great Lakes Populations Program

ICR 201304-0923-002 · OMB 0923-0044 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
MI Contact Info Sheet Form Modified Available
Network Questions - Burmese translation Form Modified Available
NY Network Questions - Burmese Form Modified Available
Interview - Burmese translation Form Modified Available
NY Interview - Burmese Form Modified Repair queued
NY Consent - Burmese translation Form Modified Available
NY Consent - Burmese Form Modified Available
Screener - Burmese translation Form Modified Available
NY Screener - Burmese Form Modified Repair queued
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 Repair queued
NY Mail-in Screener Form Modified Available
MN Participation Record Form Modified Available
MN Clinic Visit Form Modified Available
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 Consent Form Modified Available
MI Scheduling Questionnaire Form Modified Available
MI screener Form Modified Available
GreatLakes_SSA_20130403_trkchng1.docx Supplementary Document Uploaded 2013-04-10 Available
GreatLakes_SSA_20130403.docx Supplementary Document Uploaded 2013-04-10 Available
Change Request Justification ICR 0923-0044 Biomonitoring of the Great Lakes Populations Program.docx Justification for No Material/Nonsubstantive Change Uploaded 2013-04-10 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

IC Document Collections

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

ICR Details

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





Reginfo record details
22
table that charts list of burden
IC Title Form No. Form Name
MI Biomonitoring Questionnaire none
MI Contact Information Sheet none
MI Informed Consent none
MI Scheduling Questionnaire none
MI Screener none
MN Clinic Visit Form none
MN Consent none
MN Contact Information none
MN Participant Questionnaire none
MN Participation Record none
MN Recruitment Script none
MN Refusal Questions none
NY - Network Questions - Burmese none, none ,  
NY Consent none
NY Consent - Burmese none, none ,  
NY Interview - Burmese none, none ,  
NY Mail-in Screener none
NY Nonresponder Script none
NY Online Screener none
NY Questionnaire none
NY Responder Script none
NY Screener - Burmese none, none ,  

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


Reginfo record details
  No