ATSDR Exposure Investigations (EIs)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0923-0048 Supplemental Exposure Investigation at Select PFAS Exposure Assessment Sites	Form and Instruction	New	Repair queued
Att7 EI Research Determination Form-OSSigned.pdf	Supplementary Document	Uploaded 2019-01-14	Available
0923-0048 20181116a Att6_PIA_Request approved (12-18-2018).pdf	Supplementary Document	Uploaded 2019-01-14	Available
Att5 Exmple AssentConsentParental Prmssn.docx	Supplementary Document	Uploaded 2019-01-14	Available
Att4 Chem Exp Question Bank.doc	Supplementary Document	Uploaded 2019-01-14	Available
Att3 EI Map.pdf	Supplementary Document	Uploaded 2019-01-14	Available
Att2_60_day FRN 0923-0048_11_06_2018.pdf	Supplementary Document	Uploaded 2019-01-14	Available
Att1 AuthLegsl.docx	Supplementary Document	Uploaded 2019-01-14	Available
ATSDR SSB_EI Extnsn 0923-0048.docx	Supporting Statement B	Uploaded 2019-01-14	Available
ATSDR SSA_EI Extnsn 0923-0048_ICRO final.docx	Supporting Statement A	Uploaded 2019-01-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
251672	Supplemental Exposure Investigation at Select PFAS Exposure Assessment Sites	Form and Instruction	New

ICR Details

OMB Control No: 0923-0048	ICR Reference No: 201901-0923-001
Status: Active	Previous ICR Reference No: 201512-0923-001
Agency/Subagency: HHS/TSDR	Agency Tracking No: 0923-13RT
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 without change	Conclusion Date: 04/16/2019
	Date Received in OIRA: 02/13/2019
Terms of Clearance: Because EIs are not designed to link exposure with health effects, OMB will only approve the collection of health-related questions (e.g., conditions or symptoms) when ATSDR demonstrates that collection of the health-related information is necessary for interpreting exposure levels.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2022	36 Months From Approved	04/30/2019
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 3/31/2019) 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:
	83 FR 55543	11/06/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 3454	02/12/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 0

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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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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

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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: 02/13/2019

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