Pia

Save

Privacy Impact Assessment Form
v 1.21
Status

Form Number

Form Date

Question

Answer

1

OPDIV:

CDC

2

PIA Unique Identifier:

TBD

2a Name:

02/26/19

Exposure Characterization and Measurements during Activities
General Support System (GSS)
Major Application

3

Minor Application (stand-alone)

The subject of this PIA is which of the following?

Minor Application (child)
Electronic Information Collection
Unknown

3a

Identify the Enterprise Performance Lifecycle Phase
of the system.

Planning
Yes

3b Is this a FISMA-Reportable system?

4

Does the system include a Website or online
application available to and for the use of the general
public?

5

Identify the operator.

6

Point of Contact (POC):

7

Is this a new or existing system?

8

Does the system have Security Authorization (SA)?

No
Yes
No
Agency
Contractor
POC Title

Acting Branch Chief

POC Name

Elizabeth Irvin-Barnwell

POC Organization ATSDR/DTHHS/EEB
POC Email

[email protected]

POC Phone

770-488-3684
New
Existing
Yes
No

8b Planned Date of Security Authorization
Not Applicable

Page 1 of 4

Save
8c

Briefly explain why security authorization is not
required

Using multiple authorized systems for the information
collection.

10

Describe in further detail any changes to the system
that have occurred since the last PIA.

None
Concerns have been raised by the public about the safety of
recycled tire crumb rubber used in synthetic turf fields and
playgrounds in the United States. The specific research
objective of this information collection (IC) is to characterize
human exposures to potentially harmful constituents of
synthetic turf. The data will be used to inform public health
policy decisions and to guide future research activities.

11 Describe the purpose of the system.

A detailed questionnaire will be administered to determine
adult and adolescent activities associated with the use of
synthetic turf. The information to be collected is: crumb
rubber infill related exposure factors (physical activities, activity
Describe the type of information the system will
types, duration of exposure, diet, etc) and demographic
collect, maintain (store), or share. (Subsequent
12
questions will identify if this information is PII and ask information (gender, height, weight, education, race, ethnicity,
and age). For children ages 7-9 and youth ages 10-12, the
about the specific data elements.)
parent/guardian will answer the survey questions.
User access is validated by another system and no user
credentials are collected, stored, or maintained in this
information collection.

Provide an overview of the system and describe the
13 information it will collect, maintain (store), or share,
either permanently or temporarily.

This IC will use CDC's Epi Info desktop software to collect
exposure and demographic information from individuals
exposed to synthetic turf. Exposure information is collected to
determine how an individual who plays on synthetic turf fields
might be exposed to a certain class of chemical(s).
Demographic information is collected to determine if certain
populations are disproportionately affected and any factors
that might be related to an increase in exposure. Data will not
be shared outside of the ATSDR study team.
No identifiers are collected; only a participant ID is used.
Therefore, any data that is collected, maintained, or shared has
no direct identifiers.

14 Does the system collect, maintain, use or share PII?

Yes
No

REVIEWER QUESTIONS: The following section contains Reviewer Questions which are not to be filled out unless the user is an OPDIV
Senior Officer for Privacy.

Reviewer Questions
1

Are the questions on the PIA answered correctly, accurately, and completely?

Answer
Yes
No

Reviewer
Notes
2

Does the PIA appropriately communicate the purpose of PII in the system and is the purpose
justified by appropriate legal authorities?

Yes
No

Page 2 of 4

Save
Reviewer Questions

Answer

Reviewer
Notes
3

Do system owners demonstrate appropriate understanding of the impact of the PII in the
system and provide sufficient oversight to employees and contractors?

Yes
No

Reviewer
Notes
4

Does the PIA appropriately describe the PII quality and integrity of the data?

Yes
No

Reviewer
Notes
5

Is this a candidate for PII minimization?

Yes
No

Reviewer
Notes
6

Does the PIA accurately identify data retention procedures and records retention schedules?

Yes
No

Reviewer
Notes
7

Are the individuals whose PII is in the system provided appropriate participation?

Yes
No

Reviewer
Notes
8

Does the PIA raise any concerns about the security of the PII?

Yes
No

Reviewer
Notes
9

Is applicability of the Privacy Act captured correctly and is a SORN published or does it need
to be?

Yes
No

Reviewer
Notes
10

Is the PII appropriately limited for use internally and with third parties?

Yes
No

Reviewer
Notes
11

Does the PIA demonstrate compliance with all Web privacy requirements?

Yes
No

Reviewer
Notes
12

Were any changes made to the system because of the completion of this PIA?

Yes
No

Reviewer
Notes

Page 3 of 4

Save

General Comments

OPDIV Senior Official
for Privacy Signature

Jarell
Oshodi -S

Digitally signed by Jarell
HHS Senior
Oshodi -S
Agency Official
Date: 2019.03.08
for Privacy
15:58:07 -05'00'

Page 4 of 4