Prospective Birth Cohort Study Involving Environmental Uranium Exposure in the Navajo Nation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Home Environmental Assessment	Form and Instruction	Modified	Available
Eligibility Screener	Form	Modified	Available
Postpartum Survey for Mothers: 6, 9, and 12 months	Form	Modified	Available
Postpartum Survey for Mothers	Form	Modified	Available
Food Frequency Questionnaire	Form	Modified	Available
Mullen Scales of Early Learning Record Form	Form	Modified	Available
Ages and Stages Questionnaires Inventory	Form	Modified	Repair queued
Enrollment Survey for Fathers	Form	Modified	Available
Enrollment Survey for Mothers	Form	Modified	Available
Navajo_ Supp_Stmt A_ Tracked Changes_5-21-13.docx	Supplementary Document	Uploaded 2013-05-29	Available
Change Request Justification_Navajo Birth Cohort Study 05212013.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2013-05-29	Available
Navajo_ Supp_Stmt A_ CLEAN_5-21-13.docx	Supporting Statement A	Uploaded 2013-05-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
205767	Home Environmental Assessment	Form and Instruction	Modified	Home Environmental Assessment
201792	Eligibility Screener	Form	Modified	Eligibility Screener
201791	Postpartum Survey - 6, 9, 12 months	Form	Modified	Postpartum Survey for Mothers: 6, 9, and 12 months
201790	Postpartum Survey - 2 months	Form	Modified	Postpartum Survey for Mothers
201789	Food Frequency Questionnaire	Form	Modified	Food Frequency Questionnaire
201788	Mullen Stages of Early Development	Form	Modified	Mullen Scales of Early Learning Record Form
201787	Ages and Stages Questionnaire	Form	Modified	Ages and Stages Questionnaires Inventory
201786	Enrollment Survey - father	Form	Modified	Enrollment Survey for Fathers
201785	Enrollment Survey - mother	Form	Modified	Enrollment Survey for Mothers

ICR Details

OMB Control No: 0923-0046	ICR Reference No: 201305-0923-005
Status: Historical Active	Previous ICR Reference No: 201302-0923-002
Agency/Subagency: HHS/TSDR	Agency Tracking No: 19698
Title: Prospective Birth Cohort Study Involving Environmental Uranium Exposure in the Navajo Nation
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/31/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/30/2013
Terms of Clearance: Previous terms of clearance apply: Approved consistent with CDC acknowledgment that the study design limits the extent to which it can determine the impacts of uranium exposure on birth outcomes and child development. As such CDC commits to: a) making sure that its contractors set realistic expectations with its study participants, including ensuring that all recruitment materials (e.g., YouTube videos and presentations at meetings) are consistent with the study goal of improving CDCs understanding of the relationship between exposures and health endpoints rather than quantifying risk, and b) clearly articulating the limitations of the study design and, accordingly, of its conclusions when disseminating the findings to its stakeholders (including other Federal agencies, Congress, and the Navajo Nation).

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2016	02/29/2016	02/29/2016
Responses	7,400	0	7,400
Time Burden (Hours)	4,455	0	4,455
Cost Burden (Dollars)	0	0	0

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Abstract: This is a request to change the developer of the survey instruments due to system changes.

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Authorizing Statute(s): US Code: 42 USC 9604 Name of Law: CERCLA
   US Code: 42 USC 9626 Name of Law: SARA (Superfund)
  

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

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 9

table that charts list of burden

IC Title	Form No.	Form Name
Ages and Stages Questionnaire	none	Ages and Stages Questionnaires Inventory
Eligibility Screener	none	Eligibility Screener
Enrollment Survey - father	none	Enrollment Survey for Fathers
Enrollment Survey - mother	none	Enrollment Survey for Mothers
Food Frequency Questionnaire	none	Food Frequency Questionnaire
Home Environmental Assessment	none	Home Environmental Assessment
Mullen Stages of Early Development	none	Mullen Scales of Early Learning Record Form
Postpartum Survey - 2 months	none	Postpartum Survey for Mothers
Postpartum Survey - 6, 9, 12 months	none	Postpartum Survey for Mothers: 6, 9, and 12 months

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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	7,400	7,400	0	0	0	0
Annual Time Burden (Hours)	4,455	4,455	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $2,000,000

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? 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: 05/30/2013

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