ATSDR Exposure Investigations (EIs)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
PFC Exposure Investigation / Blood and Urine Sampling Questionnaire	Form and Instruction	New	Available
Form 0920-15BI Att4_ASARCO EI Participant Questionnaire	Form and Instruction	New	Available
Colorado Smelter Questionnaire	Form	Modified	Repair queued
0923-0048 - Request for Change - ATSDR Exposure Investigations.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-01-22	Available
Att5_Human Subjects Documentation_8_5_2013.pdf	Supplementary Document	Uploaded 2013-08-07	Available
Att3_AssentConsentParental Permission_8 5 2013.docx	Supplementary Document	Uploaded 2013-08-07	Repair queued
Colorado Smelter EI_GenIC_8_5_2013.docx	Supplementary Document	Uploaded 2013-08-07	Available
Att2_Colorado Smelter EI_SupStB_8_5_2013.docx	Supplementary Document	Uploaded 2013-08-07	Available
Att1_Colorado Smelter EI_SupStA_8_5_2013.docx	Supplementary Document	Uploaded 2013-08-07	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
217773	Perfluorinated Compound Biological Sampling in the Vicinity of Morgan, Lawrence, and Limestone Counties, Alabama	Form and Instruction	New	PFC Exposure Investigation / Blood and Urine Sampling Questionnaire
213701	ASARCO Smelter Exposure Investigation	Form and Instruction	New	Att4_ASARCO EI Participant Questionnaire
208122	Colorado Smelter Exposure Investigation	Form	Modified	Colorado Smelter Questionnaire

ICR Details

OMB Control No: 0923-0048	ICR Reference No: 201401-0923-001
Status: Historical Active	Previous ICR Reference No: 201305-0923-002
Agency/Subagency: HHS/TSDR	Agency Tracking No: 21339
Title: ATSDR Exposure Investigations (EIs)
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: 02/05/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/22/2014
Terms of Clearance: Previous terms of clearance apply.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2016	05/31/2016	05/31/2016
Responses	3,600	0	1,200
Time Burden (Hours)	1,800	0	600
Cost Burden (Dollars)	0	0	0

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Abstract: This is a request to add respondents and burden hours to this generic collection due to an error by CDC ICRO when the ICR was initially submitted and only one year of burden was requested.

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Authorizing Statute(s): US Code: 42 USC 9604 Name of Law: CERCLA of 1980 and Superfund Amendments and Reauthorization Act of 1986
  

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: 3

table that charts list of burden

IC Title	Form No.	Form Name
ASARCO Smelter Exposure Investigation	0920-15BI	Att4_ASARCO EI Participant Questionnaire
Colorado Smelter Exposure Investigation	none	Colorado Smelter Questionnaire
Perfluorinated Compound Biological Sampling in the Vicinity of Morgan, Lawrence, and Limestone Counties, Alabama	NA	PFC Exposure Investigation / Blood and Urine Sampling Questionnaire

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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	3,600	1,200	0	2,400	0	0
Annual Time Burden (Hours)	1,800	600	0	1,200	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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 request for additional respondents and burden hours to correct an error made by CDC when the initial request was made.

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Annual Cost to Federal Government: $960,000

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: 01/22/2014

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