Change Request Justification

0923-0056 Change Request Justification and crosswalk table.docx

Biomonitoring of Great Lakes Populations Program III

Change Request Justification

OMB: 0923-0056

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July 20, 2017


Change Request for OMB #0923-0056: Biomonitoring of the Great Lakes Populations Program III


Justification/brief Explanation for the Change Request


This is a nonmaterial/non-substantive change request for OMB protocol #0923-0056 (expiration date: July 30, 2020). OMB approval was granted for data collection for a cooperative agreement program involving the Wisconsin Department of Health Services (WI DHS).


We are requesting to make non-substantive changes to the recruitment letter/postcard (attachment 5a), appointment reminder letters (attachment 5f), and clinic visit checklists (attachments 8a and 8b) per suggestions from WI DHS external information approval reviewers and field clinic. Changes to the materials include removing unnecessary words, providing contact information for clinic staff (for questions about clinic visit or re-scheduling appointment), and adding additional check items for clinic staff (not for study participants).


Below is the change request cross-walk table. Attached please find the revised documents with both a clean version and track-change version for each document. The overall number of respondents and requested burden hours remain the same.


As such, we would appreciate your expedited consideration of this request.


Attachments

Requested Change

Justification

Att5a. Recruitment Material Invitation Letter and Postcard

If you have questions about please email [email protected] or contact Program Manager Brooke Thompson

Remove excess words. Brooke Thompson’s title “program manager” was in the signature line immediately below.

Remove publication number “p-### (mm/yyyy)” from the footer/header

The invitation letter/postcard will not be assigned a DHS publication number.

Att5f. Appointment reminder letters

Add “If you have any questions about your visit, or you need to reschedule, please call SHOW Staff at SHOW Staff phone #.”

Add clinic staff contact information for questions on clinic visit and re-scheduling

Add to the signature block “Program Manager, Wisconsin Department of Health Services

Add sender’s affiliation to the signature block of the letter

For participants will prefer to complete the paper questionnaire before appointment, add “Please finish this paper questionnaire and bring it to your appointment before your appointment

For clarification

Att8a & 8b. Clinic visit checklists and body measurements

Item 5. Add space and units to body measurements

Add the spacing and units for clinic staff to record body measurements

Item 6. Add “Blood Draw Time

Item 7. Add “Time urine sample collected

For clinic staff to record the time of blood and urine sample collection

Item 11. Add an item for the clinic staff to complete post-clinic data entry and blood/urine sample shipment.

For the clinic staff to complete post-visit activities

Add space to record note, clinic staff name, and clinic date

For clinic’s record keeping


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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorWarner, Jennifer
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File Created2021-01-22

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