Biomonitoring of Great Lakes Populations Program II

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Network Questions Sub Anglers	Form and Instruction	Modified	Available
Biomonitoring Questionnaire Sub Anglers	Form and Instruction	Modified	Available
Informed Consent Sub Anglers	Form and Instruction	Modified	Available
Eligibility Screening Sub Anglers	Form and Instruction	Modified	Available
Network Questions Bhutan Burm	Form and Instruction	Modified	Available
Biom Questionnaire Bhutan Burm	Form and Instruction	Modified	Available
Consent Bhutan Burm	Form and Instruction	Modified	Available
Screening Survey Bhutan Burm	Form and Instruction	Modified	Available
0923-0052 Change Request Justification.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-06-22	Available
0923-0052 ChgReq Cross-walk Table.docx	Supplementary Document	Uploaded 2015-06-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213781	Network Size Questions for Respondent-driven Sampling, Subsistence Anglers	Form and Instruction	Modified	Network Questions Sub Anglers
213780	Biomonitoring Interview Questionnaire, Subsistence Anglers	Form and Instruction	Modified	Biomonitoring Questionnaire Sub Anglers
213778	Informed Consent Form for Subsistence Anglers	Form and Instruction	Modified	Informed Consent Sub Anglers
213777	Eligibility Screening Survey, Subsistence Anglers	Form and Instruction	Modified	Eligibility Screening Sub Anglers
213776	Network Size Questions for Respondent-driven Sampling, Bhutanese and Burmese	Form and Instruction	Modified	Network Questions Bhutan Burm
213775	Biomonitoring Interview Questionnaire, Bhutanese and Burmese	Form and Instruction	Modified	Biom Questionnaire Bhutan Burm
213774	Informed Consent Form for Bhutanese and Burmese	Form and Instruction	Modified	Consent Bhutan Burm
213772	Eligibility Screening Survey, Bhutanese and Burmese	Form and Instruction	Modified	Screening Survey Bhutan Burm

ICR Details

OMB Control No: 0923-0052	ICR Reference No: 201506-0923-001
Status: Historical Active	Previous ICR Reference No: 201411-0923-001
Agency/Subagency: HHS/TSDR	Agency Tracking No: 14ATA
Title: Biomonitoring of Great Lakes Populations Program II
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: 06/26/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/23/2015
Terms of Clearance: Previous TOC continue to apply: Approved consistent with the understanding that the primary purpose of this project is to document the exposure distribution within each target population living in Syracuse, NY. The design does not support the ability to draw conclusions about the statistical significance of differences between either of the RDS samples and the data from nationally representative populations (e.g., NHANES), as the underlying assumptions in the samples are very different.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2017	04/30/2017	04/30/2017
Responses	942	0	942
Time Burden (Hours)	188	0	188
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC is requesting non-substantive changes to forms for clarity and consistency. There are no changes to respondents or burden hours.

---

Authorizing Statute(s): PL: Pub.L. 111 - 88 1 Name of Law: Department of Interior, Environment, and Related Agencies Appropriations Act, 2010
   US Code: 42 USC 9604 Name of Law: Comprehensive Environmental Response, Compensation and Liability Act of 1980 (CERCLA)
   US Code: 42 USC 9626 Name of Law: Superfund Amendments and Reauthorization Act of 1986 (SARA)
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 50649	08/25/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 66378	11/07/2014
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Biomonitoring Interview Questionnaire, Bhutanese and Burmese	none	Biom Questionnaire Bhutan Burm
Biomonitoring Interview Questionnaire, Subsistence Anglers	none	Biomonitoring Questionnaire Sub Anglers
Eligibility Screening Survey, Bhutanese and Burmese	none	Screening Survey Bhutan Burm
Eligibility Screening Survey, Subsistence Anglers	none	Eligibility Screening Sub Anglers
Informed Consent Form for Bhutanese and Burmese	none	Consent Bhutan Burm
Informed Consent Form for Subsistence Anglers	none	Informed Consent Sub Anglers
Network Size Questions for Respondent-driven Sampling, Bhutanese and Burmese	none	Network Questions Bhutan Burm
Network Size Questions for Respondent-driven Sampling, Subsistence Anglers	none	Network Questions Sub Anglers

---

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	942	942	0	0	0	0
Annual Time Burden (Hours)	188	188	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:

---

Annual Cost to Federal Government: $631,000

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

---

Common Form ICR:  No

---

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: 06/23/2015

---