ATSDR Exposure Investigations (EIs)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0923-0048 Form 500	Form	New	Available
Form 0923-0048 Form 400	Form	New	Available
Form 0923-0048 Form 300	Form	New	Available
Form 0923-0048 Form 200	Form	New	Available
Form 0923-0048 Form 120	Form	New	Available
Form 0923-0048 Form 110	Form	New	Available
Form 0923-0048 Form 100	Form	New	Available
Form 0923-0048 Biological Testing Tracking Form	Form and Instruction	New	Available
Form 0923-0048 Participant Questionnaire	Form and Instruction	New	Available
Att7_EI Program Determination 2021.pdf	Supplementary Document	Uploaded 2022-03-14	Repair queued
Att6 0923-0048 PIA 20220209.pdf	Supplementary Document	Uploaded 2022-03-14	Repair queued
Att5_Example AssentConsentParental Permission.docx	Supplementary Document	Uploaded 2022-03-14	Repair queued
Att4 Chem Exp Question Bank 0923_0048.docx	Supplementary Document	Uploaded 2022-03-14	Repair queued
Att3 EI Map 20130430.pdf	Supplementary Document	Uploaded 2022-03-14	Repair queued
Att2 ATSDR-0923-0048_60-day FRN.pdf	Supplementary Document	Uploaded 2022-03-14	Repair queued
Att1 AuthLegsl 20151118.docx	Supplementary Document	Uploaded 2022-03-14	Repair queued
ATSDR SSB_EI Extension 0923-0048 20221217.docx	Supporting Statement B	Uploaded 2022-03-14	Repair queued
ATSDR SSA_EI Extension 0923-0048 20211217.docx	Supporting Statement A	Uploaded 2022-03-14	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
254359	Jasper and Newton Counties Missouri Lead Exposure Investigation	Form	New	Form 500
254359	Jasper and Newton Counties Missouri Lead Exposure Investigation	Form	New	Form 400
254359	Jasper and Newton Counties Missouri Lead Exposure Investigation	Form	New	Form 300
254359	Jasper and Newton Counties Missouri Lead Exposure Investigation	Form	New	Form 200
254359	Jasper and Newton Counties Missouri Lead Exposure Investigation	Form	New	Form 120
254359	Jasper and Newton Counties Missouri Lead Exposure Investigation	Form	New	Form 110
254359	Jasper and Newton Counties Missouri Lead Exposure Investigation	Form	New	Form 100
254359	Jasper and Newton Counties Missouri Lead Exposure Investigation	Form and Instruction	New	Biological Testing Tracking Form
254359	Jasper and Newton Counties Missouri Lead Exposure Investigation	Form and Instruction	New	Participant Questionnaire

ICR Details

OMB Control No: 0923-0048	ICR Reference No: 202112-0923-002
Status: Historical Active	Previous ICR Reference No: 201901-0923-001
Agency/Subagency: HHS/TSDR	Agency Tracking No: 0923-0048
Title: ATSDR Exposure Investigations (EIs)
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: 06/15/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/14/2022
Terms of Clearance: Because EIs are not designed to link exposure with health effects, OMB will only approve the collection of health-related questions (e.g., conditions or symptoms) when ATSDR demonstrates that collection of the health-related information is necessary for interpreting exposure levels.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2025	36 Months From Approved	06/30/2022
Responses	3,600	0	3,600
Time Burden (Hours)	1,800	0	1,800
Cost Burden (Dollars)	0	0	0

---

Abstract: This is a request for a three-year extension of a generic clearance information collection request (ICR) titled the ATSDR Exposure Investigations (EI) (OMB 0923-0048, Expiration Date 4/30/2022). The ATSDR Exposure Investigations (EIs) collection is designed to allow the Agency to carry out its public health activities in a timely and efficient manner. ATSDR EIs are designed to fill gaps identified at a site when public health action is needed. ATSDR EIs include collection of both biological and environmental samples when adequate environmental or exposure information is needed to assess human exposures and possible related health effects.

---

Authorizing Statute(s): US Code: 42 USC 9604 Name of Law: CERCLA of 1980 and Superfund Amendments and Reauthorization Act of 1986
  

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 44720	08/13/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 11441	03/01/2022
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Jasper and Newton Counties Missouri Lead Exposure Investigation	0923-0048, 0923-0048, 0923-0048, 0923-0048, 0923-0048, 0923-0048, 0923-0048, 0923-0048, 0923-0048	Participant Questionnaire ,   Biological Testing Tracking Form ,   Form 100 ,   Form 110 ,   Form 120 ,   Form 200 ,   Form 300 ,   Form 400 ,   Form 500

---

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	3,600	3,600	0	0	0	0
Annual Time Burden (Hours)	1,800	1,800	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: $960,000

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.     Yes

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: 03/14/2022

---