Information Collection Request

Characterization of Exposure Potential during Activities Conducted on Synthetic Turf with Crumb Rubber Infill

ICR 201708-0923-001 · OMB 0923-0058 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Youth Exposure Measurement Form Unchanged Available
Phlebotomist Safety Exclusion Questions Form Unchanged Available
Parents/Guardians of Youth Field User Questionnaire Form Unchanged Available
Field User Eligibility Screening Script Form and Instruction Modified Available
Phlebotomist Safety Exclusion Questions Form Unchanged Available
Exposure Measurement Form Unchanged Available
Adult/Adolescent Questionnaire Form Unchanged Available
Field User Eligibility Screening Script Form and Instruction Modified Available
Change Request_OMB Control Number 0923-0058 20170828 clean.docx Justification for No Material/Nonsubstantive Change Uploaded 2017-08-28 Available
Att6 Synthetic Turf Research Protocol_Final.docx Supplementary Document Uploaded 2017-08-28 Available
Att8 US EPA Human Research Review Approval.pdf Supplementary Document Uploaded 2017-05-10 Available
Att7 CDC IRB Approval.docx Supplementary Document Uploaded 2017-05-10 Available
Att6 Synthetic Turf Research Protocol_Final.docx Supplementary Document Uploaded 2017-05-10 Available
Att5 PIA_4.21.17.pdf Supplementary Document Uploaded 2017-05-10 Available
Att4c Activity 2 ConsentAssentPermissionForms_Final.docx Supplementary Document Uploaded 2017-05-10 Available
Att4a Field User Fact Sheet_Final.docx Supplementary Document Uploaded 2017-05-10 Available
Att3 ExtrnlPeerReviewCmmnts and AgencyRspnses.docx Supplementary Document Uploaded 2017-05-10 Available
Att2a Public Comments and Agency Responses.pdf Supplementary Document Uploaded 2017-05-10 Available
Att2 60-day FRN.pdf Supplementary Document Uploaded 2017-05-10 Available
Att1 AuthLegsl.docx Supplementary Document Uploaded 2017-05-10 Available
3 - 20170427 SSB _Synthetic Turf_EC.docx Supporting Statement B Uploaded 2017-05-10 Available
3 - 20170509 SSA _Synthetic Turf_EC.docx Supporting Statement A Uploaded 2017-05-10 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
226781 Youth Exposure Measurement Form UnchangedYouth Exposure Measurement
226780 Phlebotomist Safety Exclusion Questions Form UnchangedPhlebotomist Safety Exclusion Questions
226779 Parent/Guardians of Youth Field Users Questionnaire Form UnchangedParents/Guardians of Youth Field User Questionnaire
226778 Eligibility Screening - Parents/Guardians of Youth Field Users Form and Instruction ModifiedField User Eligibility Screening Script
226777 Phlebotomist Safety Exclusion Questions Form UnchangedPhlebotomist Safety Exclusion Questions
226776 Exposure Measurement - Adult and Adolescent Field Users Form UnchangedExposure Measurement
226775 Adult and Adolescent Questionnaire Form UnchangedAdult/Adolescent Questionnaire
226774 Eligibility Screening - Adult/Adolescent Field Users Form and Instruction ModifiedField User Eligibility Screening Script

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2018 08/31/2018 08/31/2018
225 0 225
173 0 173
2,362 0 2,362





Reginfo record details
8
table that charts list of burden
IC Title Form No. Form Name
Adult and Adolescent Questionnaire none
Eligibility Screening - Adult/Adolescent Field Users NA
Eligibility Screening - Parents/Guardians of Youth Field Users NA
Exposure Measurement - Adult and Adolescent Field Users none
Parent/Guardians of Youth Field Users Questionnaire none
Phlebotomist Safety Exclusion Questions none
Phlebotomist Safety Exclusion Questions none
Youth Exposure Measurement none

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 225 225 0 0 0 0
Annual Time Burden (Hours) 173 173 0 0 0 0
Annual Cost Burden (Dollars) 2,362 2,362 0 0 0 0


Reginfo record details
  No