ATSDR Exposure Investigations (EIs)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0923-0048 Anaconda MT Exposure Investigation II - Participant Questionnaire and Sample Collection	Form and Instruction	New	Available
Form 0923-0048 Anaconda MT Exposure Investigation Questionnaire	Form and Instruction	New	Available
Dimock Water Exposure Investigation	Form	New	Available
Hayden, Arizona Smelter Exposure Investigation Questionaire	Form and Instruction	New	Available
Iola KS Exposure Investigation Questionnaire	Form and Instruction	New	Available
Att4 Chem Exp Question Bank 0923_0048.doc	Supplementary Document	Uploaded 2015-12-09	Available
Att6_EI Program Research Determntn 20151118.pdf	Supplementary Document	Uploaded 2015-12-09	Available
Att5_Example AssentConsentParental Permission.docx	Supplementary Document	Uploaded 2015-12-09	Repair queued
Att3 EI Map 20151118.pdf	Supplementary Document	Uploaded 2015-12-09	Available
Att1 AuthLegsl 20151118.docx	Supplementary Document	Uploaded 2015-12-09	Available
SSB_EI Extension 0923-0048 20151118 final.docx	Supporting Statement B	Uploaded 2015-12-09	Available
SSA_EI Extension 0923-0048 20151118 final clean.docx	Supporting Statement A	Uploaded 2016-03-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
233661	Blood Lead and Urine Arsenic Levels in Anaconda, MT - Exposure Investigation: Anaconda EI II	Form and Instruction	New	Anaconda MT Exposure Investigation II - Participant Questionnaire and Sample Collection
232880	Blood Lead and Urine Arsenic Levels in Anaconda, MT - Exposure Investigation	Form and Instruction	New	Anaconda MT Exposure Investigation Questionnaire
227129	Drinking Water Exposure Investigation - Dimock, PA	Form	New	Dimock Water Exposure Investigation
226906	Follow Up Biologic Testing for Exposure to Arsenic ASARCO Hayden Smelter Site, Hayden & Winkelman, Arizona Exposure Investigation	Form and Instruction	New	Hayden, Arizona Smelter Exposure Investigation Questionaire
226906	Follow Up Biologic Testing for Exposure to Arsenic ASARCO Hayden Smelter Site, Hayden & Winkelman, Arizona Exposure Investigation	Instruction	New
224411	Exposure Investigation - Blood Lead Levels in Iola, Kansas	Form and Instruction	New	Iola KS Exposure Investigation Questionnaire

ICR Details

OMB Control No: 0923-0048	ICR Reference No: 201512-0923-001
Status: Historical Active	Previous ICR Reference No: 201401-0923-001
Agency/Subagency: HHS/TSDR	Agency Tracking No: 21339
Title: ATSDR Exposure Investigations (EIs)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/25/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/18/2015
Terms of Clearance: Previous terms of clearance apply.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2019	36 Months From Approved	05/31/2016
Responses	3,600	0	3,600
Time Burden (Hours)	1,800	0	1,800
Cost Burden (Dollars)	0	0	0

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Abstract: This is a request for a three-year extension of a generic clearance information collection request (ICR) titled the ATSDR Exposure Investigations (EI) (OMB 0923-0048, expiration date 5/31/2016) to continue to allow the Agency to carry out its public health activities in a timely and efficient manner. When adequate environmental or exposure information to assess human exposures and possible related health effects do not exist, however, ATSDR will perform an EI.

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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
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 58735	09/30/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 78234	12/16/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Blood Lead and Urine Arsenic Levels in Anaconda, MT - Exposure Investigation	0923-0048	Anaconda MT Exposure Investigation Questionnaire
Blood Lead and Urine Arsenic Levels in Anaconda, MT - Exposure Investigation: Anaconda EI II	0923-0048	Anaconda MT Exposure Investigation II - Participant Questionnaire and Sample Collection
Drinking Water Exposure Investigation - Dimock, PA	none	Dimock Water Exposure Investigation
Exposure Investigation - Blood Lead Levels in Iola, Kansas	NA	Iola KS Exposure Investigation Questionnaire
Follow Up Biologic Testing for Exposure to Arsenic ASARCO Hayden Smelter Site, Hayden & Winkelman, Arizona Exposure Investigation	NA	Hayden, Arizona Smelter Exposure Investigation Questionaire

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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	3,600	0	0	0	0
Annual Time Burden (Hours)	1,800	1,800	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: $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: 12/18/2015

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