Supplemental Measurements for Exploratory Research regarding Exposure during Activities Conducted on Synthetic Turf Fields with Tire Crumb Rubber Infill

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0923-19GW Exposure Measurement Form	Form and Instruction	Modified	Repair queued
Form 0923-19GW Youth an Child Questionnaire	Form and Instruction	Modified	Repair queued
Form 0923-19GW Adult and Adolescent Questionnaire	Form and Instruction	Modified	Missing upstream
Form 0920-19GW Eligibility Screening Form	Form and Instruction	Modified	Repair queued
0 - 0923-0062 ChngRqust Jstfctn Crosswalk cln 20201218 final.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2021-01-12	Missing upstream
2 - AppxN8 Synthetic Turf COVID-19 Precaution Plan.docx	Supplementary Document	Uploaded 2021-01-12	Repair queued
2 - AppxN7 SiteHlthSafety Plan.docx	Supplementary Document	Uploaded 2021-01-12	Repair queued
1 - Att4_6881 Amendment #5 IRB approval.docx	Supplementary Document	Uploaded 2021-01-12	Repair queued
2 - Protocol 6881_Amendment 5 20201218 cln.docx	Supplementary Document	Uploaded 2021-01-12	Repair queued
1 - Att3_PIA_ST3 signed OCISO.pdf	Supplementary Document	Uploaded 2021-01-12	Missing upstream
2 - AppxN5b_ExpMsrtmtFormNoticePost 20201218 cln.docx	Supplementary Document	Uploaded 2021-01-12	Repair queued
2 - AppxN5a_ExpMsrtmtFormNoticePre 20201218 cln.docx	Supplementary Document	Uploaded 2021-01-12	Missing upstream
2 - AppxN3_ConsentAssentForms 20201218 cln.docx	Supplementary Document	Uploaded 2021-01-12	Missing upstream
2 - AppxN1b_FacilityOwnerFactSheet 20201218 cln.docx	Supplementary Document	Uploaded 2021-01-12	Repair queued
2 - AppxN1a_FieldUserFactSheet_20201218 cln.docx	Supplementary Document	Uploaded 2021-01-12	Repair queued
Att2a_PublicCommentandAgencyResponse.pdf	Supplementary Document	Uploaded 2019-04-23	Repair queued
Att2 60-day FRN.pdf	Supplementary Document	Uploaded 2019-04-23	Missing upstream
Att1 AuthLegsl.docx	Supplementary Document	Uploaded 2019-04-23	Missing upstream
1 - SSB_Synthetic Turf ChngRqst 20201218 cln.docx	Supporting Statement B	Uploaded 2021-01-12	Repair queued
1 - SSA_Synthetic Turf ChngRqst 20201218 cln.docx	Supporting Statement A	Uploaded 2021-01-12	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
235811	Exposure Measurement Form	Form and Instruction	Modified
235810	Youth an Child Questionnaire	Form and Instruction	Modified
235809	Adult and Adolescent Questionnaire	Form and Instruction	Modified
235808	Eligibility Screening Form	Form and Instruction	Modified

ICR Details

OMB Control No: 0923-0062	ICR Reference No: 202012-0923-002
Status: Received in OIRA	Previous ICR Reference No: 201904-0923-001
Agency/Subagency: HHS/TSDR	Agency Tracking No: 0923-0062-21BU
Title: Supplemental Measurements for Exploratory Research regarding Exposure during Activities Conducted on Synthetic Turf Fields with Tire Crumb Rubber Infill
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 01/13/2021

table that charts list comparision

	Requested	Previously Approved
Expiration Date	10/31/2021	10/31/2021
Responses	620	620
Time Burden (Hours)	184	184
Cost Burden (Dollars)	0	0

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Abstract: The research protocol, Collections Related to Synthetic Turf Fields with Crumb Rubber Infill, has been conducted previously under two information collection requests (ICRs): Activity 1 under OMB Control No. 0923-0054 (expiration date 01/31/2017) and Activities 2 and 3 under OMB Control No. 0923-0058 (expiration date 08/13/2018), which were limited to collections from August to October, 2017. Activities 2 and 3 aim to evaluate and characterize the human exposure potential to constituents in crumb rubber infill among a convenience sample of 60 field users (Activity 2) and to collect biological specimens (blood and urine) from 45 participants (Activity 3). Due to the limited enrollment and collection period, the target Activity 2 and Activity 3 samples sizes were not met in 2017. This change request reflects modifications to the currently approved information collection request (ICR) and reflects the need to practice social distancing to the extent possible. Where necessary, ATSDR has modified its scripts and forms to let the public know of the COVID-19 precautions that the agency is implementing.

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Authorizing Statute(s): US Code: 42 USC 103 Name of Law: Comprehensive Environmental Response, Compensation and Liability Act of 1980 (CERCLA)
   US Code: 42 USC 9604(i)(1)(E), (7), (9) Name of Law: 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 66265	12/26/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 16856	04/23/2019
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Eligibility Screening Form	0920-19GW	Eligibility Screener
Adult and Adolescent Questionnaire	0923-19GW	Adult/Ado Field Questionnaire
Youth an Child Questionnaire	0923-19GW	Youth/Child Field Questionnaire
Exposure Measurement Form	0923-19GW	Exposure Measurement Form

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	620	620	0	0	0	0
Annual Time Burden (Hours)	184	184	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: This is a New Collection

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Annual Cost to Federal Government: $400,000

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.     No

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? No

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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: 01/13/2021

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