Information Collection Request

Collections Related to Synthetic Turf Fields with Crumb Rubber Infill

ICR 201608-0923-001 · OMB 0923-0054 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Activity 2 - Exposure Measurement Form Form and Instruction Unchanged Available
Activity 2 - Phlebotomist Safety Exclusion Questions Form and Instruction Unchanged Available
Activity 2 - Youth and Child Questionnaire (Parents/Guardians of Youth/Child Facility Users) Form and Instruction Modified Available
Activity 2 - Eligibility Screening Script (Parents/Guardians of Youth/Child Facility Users) Form and Instruction Unchanged Available
Activity 2 - Phlebotomist Safety Exclusion Questions Form and Instruction Unchanged Available
Activity 2 - Exposure Measurement Form Form and Instruction Unchanged Available
Activity 2 - Adult and Adolescent Questionnaire (Adult/Adolescent Facility Users) Form and Instruction Unchanged Available
Activity 2 - Eligibility Screening Script (Adult/Adolescent Facility Users) Form and Instruction Modified Available
Activity 1 - Synthetic Turf Field Facility Sampling Collection Form Form and Instruction Unchanged Available
Synthetic Turf Field Facility Owner/Manager Questionnaire Form and Instruction Unchanged Available
Activity 1 - Synthetic Turf Field Facility Eligibility Screening Script Form and Instruction Unchanged Available
Activity 1 - Tire Recycling Plant Sample Collection Form Form and Instruction Unchanged Available
Activity 1 - Tire Recycling Plant Telephone Script Form and Instruction Unchanged Available
Att5c Activity 2 ConsentAssentPermissionForms_Clean 8.1.16.docx Supplementary Document Uploaded 2016-08-02 Available
Att5a Field User Fact Sheet_20160801_Clean.docx Supplementary Document Uploaded 2016-08-02 Available
Att4g SynTurfFldFacilSmpleCollctnAgrmntForm_20160801_Clean.docx Supplementary Document Uploaded 2016-08-02 Available
Att4e Synthetic Turf Field Facility Fact Sheet_20160801_Clean.docx Supplementary Document Uploaded 2016-08-02 Available
Att4c TireRecyclngFacil Sample Collctn Agrmnt Form_20160801_Clean.docx Supplementary Document Uploaded 2016-08-02 Available
Att4a Tire Recycling Plant Fact Sheet_20160801_Clean.docx Supplementary Document Uploaded 2016-08-02 Available
Att8 CDC IRB Approval 20160729.pdf Supplementary Document Uploaded 2016-08-02 Repair queued
Change Request Justification - 0923-0054 Synthetic Turf.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-08-02 Available
Att5c Activity 2 ConsentAssentPermissionForms_20160716 clean.docx Supplementary Document Uploaded 2016-07-21 Available
Att5a Field User Fact Sheet_20160716 clean.docx Supplementary Document Uploaded 2016-07-21 Available
Att4g SynTurfFldFacilSmpleCollctnAgrmntForm_20160716 clean.docx Supplementary Document Uploaded 2016-07-21 Available
Att4e Synthetic Turf Field Facility Fact Sheet_20160716 clean.docx Supplementary Document Uploaded 2016-07-21 Available
Att4c TireRecyclngFacil Sample Collctn Agrmnt Form_20160718 clean.docx Supplementary Document Uploaded 2016-07-21 Available
Att4a Tire Recycling Plant Fact Sheet_20160716 clean.docx Supplementary Document Uploaded 2016-07-21 Available
SSB _Synthetic Turf_20160716 clean.docx Supporting Statement B Uploaded 2016-07-21 Available
SSA _Synthetic Turf_20160720 clean.docx Supporting Statement A Uploaded 2016-07-21 Available
Att9 US EPA Human Research Review Approval.pdf Supplementary Document Uploaded 2016-07-13 Available
Att8 CDC IRB Approval.docx Supplementary Document Uploaded 2016-07-13 Repair queued
Att7 Research Protocol.docx Supplementary Document Uploaded 2016-07-13 Available
Att3 ExtrnlPeerReviewCmmnts and AgencyRspnses.docx Supplementary Document Uploaded 2016-07-13 Available
Att2a Responses to Public Comments.docx Supplementary Document Uploaded 2016-07-13 Available
Att2a Category 8 - Previous Studies and Literature Review Comments.pdf Supplementary Document Uploaded 2016-07-13 Available
Att2a Category 7 - Epidemiological study comments.pdf Supplementary Document Uploaded 2016-07-13 Available
Att2a Category 6 - Methodology Comments.pdf Supplementary Document Uploaded 2016-07-13 Available
Att2a Category 5 - Detailed Requests.pdf Supplementary Document Uploaded 2016-07-13 Available
Att2a Category 4 - Banning moratorium and precautionary principle comments.pdf Supplementary Document Uploaded 2016-07-13 Available
Att2a Category 3 - Beyond the Scope Comments.pdf Supplementary Document Uploaded 2016-07-13 Available
Att2a Category 2 - Children and Childrens Health Comments.pdf Supplementary Document Uploaded 2016-07-13 Available
Att2a Category 1 - General Comments.pdf Supplementary Document Uploaded 2016-07-13 Available
ATSDR 30-Day FRN_Synthetic Turf.docx Supplementary Document Uploaded 2016-07-12 Available
Att2 60d FRN SynthcTrf Crumb Rubber 20160218.pdf Supplementary Document Uploaded 2016-07-12 Available
Att1 AuthLegsl.docx Supplementary Document Uploaded 2016-07-12 Available
20160711 OMBEmerRqustMemo Synthetic Turf 7.11.16_Signed.pdf Supplementary Document Uploaded 2016-07-12 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
222469 Activity 2 - Exposure Measurement Form (Youth/Child Facility Users Form and Instruction UnchangedActivity 2 - Exposure Measurement Form
222468 Activity 2 - Phlebotomist Safety Exclusion Questions Form (Parents/Guardians of Youth/Child Facility Users) Form and Instruction UnchangedActivity 2 - Phlebotomist Safety Exclusion Questions
222467 Activity 2 - Youth and Child Questionnaire - (Parents/Guardians of Youth/Child Facility Users) Form and Instruction ModifiedActivity 2 - Youth and Child Questionnaire (Parents/Guardians of Youth/Child Facility Users)
222466 Activity 2 - Eligibility Screening Script (Parents/Guardians of Youth/Child Facility Users) Form and Instruction UnchangedActivity 2 - Eligibility Screening Script (Parents/Guardians of Youth/Child Facility Users)
222465 Activity 2 - Phlebotomist Safety Exclusion Questions Form - (Adult/Adolescent Facility Users) Form and Instruction UnchangedActivity 2 - Phlebotomist Safety Exclusion Questions
222464 Activity 2 - Exposure Measurement Form - (Adult/Adolescent Facility Users) Form and Instruction UnchangedActivity 2 - Exposure Measurement Form
222463 Activity 2 - Adult and Adolescent Questionnaire (Adult/Adolescent Facility Users) Form and Instruction UnchangedActivity 2 - Adult and Adolescent Questionnaire (Adult/Adolescent Facility Users)
222460 Activity 2 - Eligibility Screening Script (Adult/Adolescent Facility Users) Form and Instruction ModifiedActivity 2 - Eligibility Screening Script (Adult/Adolescent Facility Users)
222459 Activity 1 - Field Sampling Collection Form Form and Instruction UnchangedActivity 1 - Synthetic Turf Field Facility Sampling Collection Form
222458 Activity 1 - Owner Manager Questionnaire Form and Instruction UnchangedSynthetic Turf Field Facility Owner/Manager Questionnaire
222457 Activity 1 - Eligibility Screening Form Form and Instruction UnchangedActivity 1 - Synthetic Turf Field Facility Eligibility Screening Script
222456 Activity 1 - Facility Sampling Collection Form Form and Instruction UnchangedActivity 1 - Tire Recycling Plant Sample Collection Form
222455 Activity 1 - Invitation Telephone Script Form and Instruction UnchangedActivity 1 - Tire Recycling Plant Telephone Script

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2017 01/31/2017 01/31/2017
379 0 379
333 0 333
0 0 0





Reginfo record details
13
table that charts list of burden
IC Title Form No. Form Name
Activity 1 - Eligibility Screening Form NA
Activity 1 - Facility Sampling Collection Form NA
Activity 1 - Field Sampling Collection Form NA
Activity 1 - Invitation Telephone Script NA
Activity 1 - Owner Manager Questionnaire NA
Activity 2 - Adult and Adolescent Questionnaire (Adult/Adolescent Facility Users) NA
Activity 2 - Eligibility Screening Script (Adult/Adolescent Facility Users) NA
Activity 2 - Eligibility Screening Script (Parents/Guardians of Youth/Child Facility Users) NA
Activity 2 - Exposure Measurement Form (Youth/Child Facility Users NA
Activity 2 - Exposure Measurement Form - (Adult/Adolescent Facility Users) NA
Activity 2 - Phlebotomist Safety Exclusion Questions Form (Parents/Guardians of Youth/Child Facility Users) NA
Activity 2 - Phlebotomist Safety Exclusion Questions Form - (Adult/Adolescent Facility Users) NA
Activity 2 - Youth and Child Questionnaire - (Parents/Guardians of Youth/Child Facility Users) NA

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 379 379 0 0 0 0
Annual Time Burden (Hours) 333 333 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No