Information Collection Request

Human Health Effects of Drinking Water Exposures to Per- and Polyfluoroalkyl Substances (PFAS) at Pease International Tradeport, Portsmouth, NH (The Pease Study)

ICR 201909-0923-001 · OMB 0923-0061 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Medical Record Abstraction - Child Form Unchanged Repair queued
Medical Record Abstraction - Adult Form Unchanged Repair queued
Child School Record Abstraction Form Unchanged Repair queued
Child Questionnaire - Short Form Form Unchanged Repair queued
Child Questionnaire - Long Form Form Unchanged Repair queued
Adult Questionnaire Form Unchanged Repair queued
Blood Draw and Urine Collection Form Form Unchanged Repair queued
Body and Blood Pressure Measures Form Form Unchanged Repair queued
Medication List Form Unchanged Repair queued
Update Contact Information Hardcopy Form Form Unchanged Repair queued
Appointment Reminder Telephone Script Form and Instruction Unchanged Repair queued
Wave Three Eligibility Screening Script Form and Instruction Unchanged Repair queued
Wave Two Eligibility Screening Script Form and Instruction Unchanged Repair queued
Wave One Elligibility Screening Script Form and Instruction Unchanged Repair queued
P_Att09b_InformedConsentPacket_20190823 clean.docx Supplementary Document Uploaded 2019-09-05 Available
Pease Study Protocol 20190823 clean.docx Supplementary Document Uploaded 2019-09-05 Available
1 - AppndxE IRB Apprvl Memos 20190903.pdf Supplementary Document Uploaded 2019-09-05 Available
0923-0061 Change Request Justification 20190903.docx Justification for No Material/Nonsubstantive Change Uploaded 2019-09-05 Repair queued
0 - SSB Pease Study 20190813 clean.docx Supporting Statement B Uploaded 2019-08-16 Repair queued
0 - SSA Pease Study 20190815.docx Supporting Statement A Uploaded 2019-08-16 Available
0 - Pease Study Protocol 20190813 clean.docx Supplementary Document Uploaded 2019-08-15 Available
P_Att24a_ATSDRPFASFactsheet.pdf Supplementary Document Uploaded 2019-08-15 Repair queued
P_Att24_PFASResultsReport 20190813 clean.docx Supplementary Document Uploaded 2019-08-15 Available
P_Att23_ClinicalTestResultsReport_20180802.docx Supplementary Document Uploaded 2019-08-15 Repair queued
P_Att22b_LetterRprtCriticalValue_20180802.docx Supplementary Document Uploaded 2019-08-15 Available
P_Att22a_AdvncClinicalTestReportTrackingForm_20180802.docx Supplementary Document Uploaded 2019-08-15 Repair queued
P_Att22_AdvReportScriptClinicalTests_20180802.docx Supplementary Document Uploaded 2019-08-15 Available
P_Att21_BodyBloodPressMsReport_20180802.docx Supplementary Document Uploaded 2019-08-15 Available
P_Att14 PeaseManualofProcedures_rev110918x.docx Supplementary Document Uploaded 2019-08-15 Available
P_Att11_ApptTrackingForm_20180802.docx Supplementary Document Uploaded 2019-08-15 Repair queued
P_Att09c_StudyFactSheet_20180802.docx Supplementary Document Uploaded 2019-08-15 Available
P_Att09b_InformedConsentPacket_20190813 clean.docx Supplementary Document Uploaded 2019-08-15 Available
P_Att09a_ApptReminderCard_20180802.docx Supplementary Document Uploaded 2019-08-15 Repair queued
P_Att08_RecrTrackingForm_20180802.docx Supplementary Document Uploaded 2019-08-15 Repair queued
P_Att07_WavesTwoThreeRecruitmentMaterials_20180802.docx Supplementary Document Uploaded 2019-08-15 Repair queued
P_Att06_WaveOne_NHDHHSInvitationLttrsStudyRollout_20181218 clean.docx Supplementary Document Uploaded 2019-08-15 Repair queued
P_Att05_PeaseStudyCommnctnPlan_20190813 clean.docx Supplementary Document Uploaded 2019-08-15 Repair queued
P_Att04_JustificationSampleSizeCalcs 20180802.docx Supplementary Document Uploaded 2019-08-15 Available
P_Att03_BiochemAnalPlanChildrenAdults 20181109_clean.docx Supplementary Document Uploaded 2019-08-15 Repair queued
P_Att02_PFASLevelsPease_vs_ExtrnlPopn 20180802.docx Supplementary Document Uploaded 2019-08-15 Repair queued
P_Att01_InvestigatorsKeyPersonnel updated 20180802.docx Supplementary Document Uploaded 2019-08-15 Repair queued
AppndxF_Data Sharing and Disclosure Review 20190813.docx Supplementary Document Uploaded 2019-08-15 Available
AppndxE IRB Approval Memo 20180912.pdf Supplementary Document Uploaded 2019-08-15 Available
AppndxD PrivacyImpactAssessment 20181210.pdf Supplementary Document Uploaded 2019-08-15 Repair queued
AppndxC_Pease_Feasibility_Assessment_November-2017_508.pdf Supplementary Document Uploaded 2019-08-15 Repair queued
AppndxB1 ATSDR-2018-0008 SmmryCmntsRspnses 20190813.pdf Supplementary Document Uploaded 2019-08-15 Available
AppndxB Pease 60-day FRN.pdf Supplementary Document Uploaded 2018-12-20 Repair queued
AppndxA Pease_Study_ Authorizing Legislation 20180802.pdf Supplementary Document Uploaded 2018-12-20 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
237378 Request for Medical Record Abstraction Instruction Unchanged
237377 Request for Child School Record Abstraction Instruction Unchanged
234702 Medical Record Abstraction - Child Form Unchanged
234701 Medical Record Abstraction - Adult Form Unchanged
234700 Child School Record Abstraction Form Unchanged
234699 Child Neurobehavioral Test Battery Instruction Unchanged
234698 Parent Neurobehavioral Test Battery Instruction Unchanged
234697 Child Questionnaire - Short Form Form Unchanged
234696 Child Questionnaire - Long Form Form Unchanged
234695 Adult Questionnaire Form Unchanged
234694 Blood Draw and Urine Collection Form Form Unchanged
234693 Body and Blood Pressure Measures Form Form Unchanged
234692 Medication List Form Unchanged
234691 Update Contact Information Hardcopy Form Form Unchanged
234690 Appointment Reminder Telephone Script Form and Instruction Unchanged
234689 Wave Three Eligibility Screening Script Form and Instruction Unchanged
234688 Wave Two Eligibility Screening Script Form and Instruction Unchanged
234687 Wave One Elligibility Screening Script Form and Instruction Unchanged
ICR Details
0923-0061 201909-0923-001
Historical Active 201908-0923-001
HHS/TSDR 0923-0061
Human Health Effects of Drinking Water Exposures to Per- and Polyfluoroalkyl Substances (PFAS) at Pease International Tradeport, Portsmouth, NH (The Pease Study)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 09/10/2019
Retrieve Notice of Action (NOA) 09/05/2019
Previous terms continue: Consistent with the Supporting Statement, the statistical power and sampling frame of this proof of concept study limits ATSDR’s ability to detect moderate differences (between exposed and nonexposed individuals) in many of health conditions queried in this collection. Approval for the collection of information about conditions for which there is not adequate statistical power is provided specifically for the purposes of evaluating the study procedures, methods, and hypotheses for a future multi-site study. Approval is provided contingent upon a commitment to investigate other contributing environmental factors when associations or trends are observed between PFAS exposure and health conditions. Approval is also provided contingent upon a commitment to work with the National Center for Health Statistics on disclosure review procedures and include a member of NCHS’s disclosure review board for NHANES on the PEAS disclosure review board.
  Inventory as of this Action Requested Previously Approved
08/31/2022 08/31/2022 08/31/2022
5,852 0 5,852
1,454 0 1,454
42,227 0 42,227

The Pease Study will serve as a proof-of-concept model for a multi-site study of PFAS health effects. The existence of a large body of state and local environmental monitoring and population blood testing data makes the Pease community in Portsmouth, NH particularly suitable as ATSDR’s initial PFAS research study site. The main goals of the research study are to: 1) evaluate the study procedures and methods to identify any changes to the design or protocol that need to be made before embarking on a multi-site study; and 2) examine associations between a limited number of health outcomes for which statistical power is adequate and measured and historically reconstructed serum levels of PFAS (e.g., lipids, renal function and kidney disease, thyroid hormones and disease, liver function and disease, glycemic parameters and diabetes, as well as immune response and function in both children and adults). Request for change to retain leftover blood with participant consent.

US Code: 42 USC 301 Name of Law: PHSA
   PL: Pub.L. 115 - 141 8006 Name of Law: Consolidated Appropriations Act
   US Code: 42 USC 9604 Name of Law: CERCLA
  
None

Not associated with rulemaking

  83 FR 43685 08/27/2018
84 FR 3449 02/12/2019
Yes

  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 5,852 5,852 0 0 0 0
Annual Time Burden (Hours) 1,454 1,454 0 0 0 0
Annual Cost Burden (Dollars) 42,227 42,227 0 0 0 0
No
No
This is a resubmission of a new ICR.

$1,912,122
Yes Part B of Supporting Statement
    Yes
    Yes
No
No
No
Uncollected
Shari Steinberg 404 639-4942 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
09/05/2019