Request for Change

July 16, 2019

Change Request for OMB # 0923-0059: Per- or Polyfluoroalkyl Substances Exposure Assessments (PFAS EAs)

Justification for the Change Request

This is a non-material/non-substantive change request for OMB protocol #0923-0059 (expiration date: June 30, 2022). OMB approval was granted for data collection for “Pre-and Polyfluoroalkyl Substances Exposure Assessments (PFAS EAs).”

We are requesting to make a non-substantive change to the Assent Form (12 to 17 years) for the EAs (Appendix B4 of the PFAS EA protocol). A section of the form is being deleted because the information provided in the section (contact information) is already available on the form and does not need to be repeated. In addition, the section is not present in the Adult Consent form (Appendix B2) or the Parental Permission form (Appendix B3). Removal of the section will make all the consent forms consistent.

Below is the change request cross-walk table. Attached please find the revised document with both a clean version and track-change version. The overall number of respondents and requested burden hours remain the same.

As such, we would appreciate your expedited consideration of this request.

Attachment	Requested Change	Justification
PrtApndxB4_Assent Form for Minors	Do you want more information? We will give you a copy of this form to keep. If you have any questions, concerns, or complaints about this assessment, please contact the following people: If you have questions about this assessment or questions related to injury from the assessment, call (insert name and phone number of Study coordinator). If you have questions about your rights as a participant in this assessment, please call (insert name and phone number of Study coordinator).	This section is not found in the Adult Consent form or the Parental Permission form. Deleting it from the Assent form will make all consent forms consistent. The contact information provided in the deleted section is already provided in the form and does not need to be repeated.

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