Household Recruitment Script for Environmental Sampling

Form Approved

OMB No. 0923-xxxx

Exp. Date xx/xx/20xx

Appendix A4: Household Recruitment Script for Environmental Sampling

PFAS Exposure Assessment, environmental sampling

Household Recruitment Script for Environmental Sampling

ATSDR estimates the average public reporting burden for this collection of information as 5 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0923-xxxx).

Reading Level: 10.1

Note: Ten percent of household recruited into the exposure assessment that report drinking tap water in the home will be randomly selected for environmental sampling. This script will be used to contact and invite these selected households to participate in environmental sampling.

Hello, I am ______________________ from [insert affiliation], calling on behalf of the Agency for Toxic Substances and Disease Registry. May I please speak with the head of the household?

As I’m sure you remember, your household recently agreed to participate in an exposure assessment to measure chemicals called per- and polyfluoroalkyl substances, or PFAS, in the bodies of people living in your area. A small subset of households participating in the exposure assessment has been selected for additional environmental sampling of PFAS in the home.

We would like to collect tap water and indoor dust samples from some homes to understand how people living in your area are exposed to PFAS while at home. To do this, we need households in this community to participate in environmental sampling as well as blood and urine testing.

For this part of the exposure assessment, we will collect a drinking water sample from the source in your home you and your family most often drink water (e.g. kitchen tap). Then, we will collect indoor dust samples from up to three locations inside your home. The time required for us to collect these samples is estimated to be about 20 minutes. The environmental sampling will be in addition to collection of blood and urine from you and others in your household.

Are you willing to participate in the environmental sampling part of the exposure assessment?

Yes No Refused to Answer

If No: Okay, thank you for your time. Goodbye.

If Yes: Thank you very much. We will be in your community to collect samples [insert dates]. Your blood and urine sampling appointment is at [insert date and time]. When would be a good time for us to schedule a home visit to collect your environmental samples?