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 0923-0062 Exposure Measurement Form	Form and Instruction	Modified	Available
Form 0923-0062 Exposure Measurement Form	Form and Instruction	Modified	Repair queued
Form 0923-0062 Youth/Child Field Questionnaire	Form and Instruction	Modified	Available
Form 0923-0062 Youth an Child Questionnaire	Form and Instruction	Modified	Repair queued
Form 0923-0062 Adult/Ado Field Questionnaire	Form and Instruction	Modified	Available
Form 0923-0062 Adult and Adolescent Questionnaire	Form and Instruction	Modified	Repair queued
Form 0923-0062 Eligibility Screener	Form and Instruction	Modified	Available
Form 0923-0062 Eligibility Screening Form	Form and Instruction	Modified	Repair queued
P_AppxN8 Synthetic Turf COVID-19 PrecautnPln 20210222 cln.docx	Supplementary Document	Uploaded 2021-06-15	Repair queued
P_AppxN7 SiteHlthSafety Plan 20210222 cln.docx	Supplementary Document	Uploaded 2021-06-15	Repair queued
Att4 IRB 6881 Amendment6 Approval.docx	Supplementary Document	Uploaded 2021-06-15	Repair queued
P_Protocol 6881_Amendment 6 20210222 cln.docx	Supplementary Document	Uploaded 2021-06-15	Repair queued
Att3_Privacy Threshold Analysis.pdf	Supplementary Document	Uploaded 2021-06-15	Repair queued
P_AppxN5b_ExpMsrtmtFormNoticePost 20210222 cln.docx	Supplementary Document	Uploaded 2021-06-15	Repair queued
P_AppxN5a_ExpMsrtmtFormNoticePre 20210222 cln.docx	Supplementary Document	Uploaded 2021-06-15	Repair queued
P_AppxN3_ConsentAssentForms 20210222 cln.docx	Supplementary Document	Uploaded 2021-06-15	Repair queued
P_AppxN1b_FacilityOwnerFactSheet 20210222 cln.docx	Supplementary Document	Uploaded 2021-06-15	Available
P_AppxN1a_FieldUserFactSheet 20210222 cln.docx	Supplementary Document	Uploaded 2021-06-15	Repair queued
Att2 60-day FRN ST3.pdf	Supplementary Document	Uploaded 2021-06-15	Repair queued
Att1 AuthLegsl.docx	Supplementary Document	Uploaded 2021-06-15	Repair queued
1 - SSB_Synthetic Turf Extension_cln.docx	Supporting Statement B	Uploaded 2021-06-15	Available
1 - SSA_Synthetic Turf Extension cln_final.docx	Supporting Statement A	Uploaded 2021-06-15	Available

IC Document Collections

Information collection document groups

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

ICR Details

OMB Control No: 0923-0062	ICR Reference No: 202106-0923-001
Status: Historical Active	Previous ICR Reference No: 202012-0923-002
Agency/Subagency: HHS/TSDR	Agency Tracking No: 0923-0062
Title: Supplemental Measurements for Exploratory Research regarding Exposure during Activities Conducted on Synthetic Turf Fields with Tire Crumb Rubber Infill
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/28/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/24/2021
Terms of Clearance: Prior terms of clearance continue.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2023	24 Months From Approved	10/31/2021
Responses	620	0	620
Time Burden (Hours)	184	0	184
Cost Burden (Dollars)	0	0	0

---

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 is a request for a 2 year extension to finish collecting samples.

---

Authorizing Statute(s): US Code: 42 USC 9604(i)(1)(E), (7), (9) Name of Law: Superfund Amendments and Reauthorization Act of 1986
   US Code: 42 USC 103 Name of Law: Comprehensive Environmental Response, Compensation and Liability Act of 1980 (CERCLA)
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 9340	02/12/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 33300	06/24/2021
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Adult and Adolescent Questionnaire	0923-0062	Adult/Ado Field Questionnaire
Eligibility Screening Form	0923-0062	Eligibility Screener
Exposure Measurement Form	0923-0062	Exposure Measurement Form
Youth an Child Questionnaire	0923-0062	Youth/Child Field Questionnaire

---

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	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:

---

Annual Cost to Federal Government: $410,000

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

---

Common Form ICR:  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:

(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: 06/24/2021

---