Blood Lead Surveillance System (BLSS) - NIOSH

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0931 ABLES Aggregate Records Form and Brief Narrative Report	Form and Instruction	Unchanged	Available
Form 0920-0931 ABLES Case Records Form and Brief Narrative Report	Form and Instruction	Unchanged	Available
Form 0920-0931 CBLS Variables - FY18 State or Local Health Departments	Form and Instruction	Unchanged	Repair queued
Form 0920-0931 CBLS Variables - FY17 State or Local Health Departments	Form and Instruction	Modified	Repair queued
Form 0920-0931 CBLS Aggregate Records - FY14/FY17 State or Local Health Departments	Form and Instruction	Unchanged	Repair queued
Form 0920-0931 CBLS Variables - FY14/FY17 State or Local Health Departments	Form and Instruction	Unchanged	Repair queued
Form 0920-0931 HHLPSS Variables	Form and Instruction	Unchanged	Available
Change Request_OMB Control Number 0920-0931 (race) 06202019.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2019-07-02	Available
Att7a1 ABLES Standardized Variable Formats (track changes).docx	Supplementary Document	Uploaded 2019-07-02	Available
Att7a1 ABLES Standardized Variable Formats (clean).docx	Supplementary Document	Uploaded 2019-07-02	Repair queued
Att6b CBLS Variables Txt Files (track changes).doc	Supplementary Document	Uploaded 2019-07-02	Available
Request for Change 0920-0931.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2018-05-18	Available
Att11 2015 HHLPSS Notice of Action & Terms of Clearance.pdf	Supplementary Document	Uploaded 2018-05-15	Available
ABLES website pre-clearance draft.docx	Supplementary Document	Uploaded 2018-05-15	Available
Att10 OMBCntrlNoHstry for BLSurvllnce 20180511 clean.DOCX	Supplementary Document	Uploaded 2018-05-15	Available
Att9b NIOSH ABLES Research Determination.pdf	Supplementary Document	Uploaded 2018-05-15	Available
Att9a NCEH CBLS Research Determination.pdf	Supplementary Document	Uploaded 2018-05-15	Available
Att8b ABLES PIA_Determination 2018Apr04.pdf	Supplementary Document	Uploaded 2018-05-15	Available
Att8a NCEH CBLS PIA Recert 2016.pdf	Supplementary Document	Uploaded 2018-05-15	Available
Att7c ABLES Changes in Data Elements.xlsx	Supplementary Document	Uploaded 2018-05-15	Repair queued
Att6d CBLS Differences in Variable Reporting Requirements.xlsx	Supplementary Document	Uploaded 2018-05-15	Repair queued
Att5a NCEH CBLS Program Summary & Accomplishments.docx	Supplementary Document	Uploaded 2018-05-15	Available
Att4b NCEH NOFO CDC-RFA-EH14-1408.pdf	Supplementary Document	Uploaded 2018-05-15	Available
Att4a NCEH NOFO CDC-RFA-EH17-1701.pdf	Supplementary Document	Uploaded 2018-05-15	Available
Att3 NIOSH ABLES Inclusion History in NCEH ICRs.xlsx	Supplementary Document	Uploaded 2018-05-15	Available
Att2a 60-dyFRN CBLS-ABLES new ICR.pdf	Supplementary Document	Uploaded 2018-05-15	Available
Att1b NIOSH Authority.pdf	Supplementary Document	Uploaded 2018-05-15	Available
Att1a NCEH Authority (combined).pdf	Supplementary Document	Uploaded 2018-05-15	Available
BLSS_SSB_FINAL 15MAY2018.DOCX	Supporting Statement B	Uploaded 2018-05-15	Available
BLSS_SSA_FINAL 15MAY2018.docx	Supporting Statement A	Uploaded 2018-05-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
231454	ABLES Aggregate Records Form and Brief Narrative Report	Form and Instruction	Unchanged
231453	ABLES Case Records Form and Brief Narrative Report	Form and Instruction	Unchanged
231451	CBLS Variables - FY18 State or Local Health Departments	Form and Instruction	Unchanged
231450	CBLS Variables - FY17 State or Local Health Departments	Form and Instruction	Modified
231449	CBLS Aggregate Records - FY14/FY17 State or Local Health Departments	Form and Instruction	Unchanged
231448	CBLS Variables - FY14/FY17 State or Local Health Departments	Form and Instruction	Unchanged
231447	HHLPSS Variables	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-0931	ICR Reference No: 201907-0920-003
Status: Active	Previous ICR Reference No: 201805-0920-006
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0931-18AHR
Title: Blood Lead Surveillance System (BLSS) - NIOSH
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/10/2019
	Date Received in OIRA: 07/03/2019
Terms of Clearance: Previous TOC still apply.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2021	05/31/2021	05/31/2021
Responses	409	0	409
Time Burden (Hours)	1,226	0	1,226
Cost Burden (Dollars)	0	0	0

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Abstract: This change will comply with the HHS uniform data collection standards.(full document available here) https://intranet.cdc.gov/os/osi/icro/docs/HHS_Data_Collection_Standards.pdf (Public facing website) https://aspe.hhs.gov/basic-report/hhs-implementation-guidance-data-collection-standards-race-ethnicity-sex-primary-language-and-disability-status

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Research and investigations generally
   PL: Pub.L. 111 - 148 4002 Name of Law: Patient Protection and Affordable Care Act
   PL: Pub.L. 114 - 322 2204 Name of Law: Water Infrastructure Improvements for the Nation (WIIN) Act
   PL: Pub.L. 91 - 596 20 Name of Law: 1970 Occupational Safety and Health Act
  

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:
	82 FR 16839	04/06/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 52047	11/09/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
HHLPSS Variables	0920-0931	HHLPSS Variables
CBLS Variables - FY14/FY17 State or Local Health Departments	0920-0931	CBLS Variables - Text Files
CBLS Aggregate Records - FY14/FY17 State or Local Health Departments	0920-0931	CBLS Aggregate Records - Excel
CBLS Variables - FY17 State or Local Health Departments	0920-0931	CBLS Variables - Text Files
CBLS Variables - FY18 State or Local Health Departments	0920-0931	CBLS Variables - Text Files
ABLES Case Records Form and Brief Narrative Report	0920-0931	ABLES Case Records Form and Brief Narrative Report
ABLES Aggregate Records Form and Brief Narrative Report	0920-0931	ABLES Aggregate Records Form and Brief Narrative Report

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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	409	409	0	0	0	0
Annual Time Burden (Hours)	1,226	1,226	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: Revision of 0920-0931 serves to combine efforts from NCEH and NIOSH into the ICR Blood Lead Level Surveillance. It results in an increase in 586 Burden Hours

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Annual Cost to Federal Government: $7,780,833

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.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

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: 07/03/2019

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