Information Collection Request
[ATSDR] Human Health Effects of Drinking Water Exposures to Per- and Polyfluoroalkyl Substances (PFAS): A Multi-site Cross-sectional Study
ICR 202305-0923-001 · OMB 0923-0063 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Drinking Water Information Collection (Environmental Protection Agencies) |
Form and Instruction | Unchanged | Repair queued |
| Drinking Water Information Collection (Public Water Purveyors) |
Form and Instruction | Unchanged | Repair queued |
| Child School Record Abstraction |
Form and Instruction | Modified | Repair queued |
| Medical Record Abstraction - Child |
Form and Instruction | Modified | Repair queued |
| Medical Record Abstraction - Adult |
Form and Instruction | Modified | Repair queued |
| Child Neurobehavioral Test Battery |
Form and Instruction | Modified | Repair queued |
| Parent Neurobehavioral Test Battery |
Form and Instruction | Modified | Repair queued |
| Child Questionnaire - Short Form |
Form and Instruction | Modified | Repair queued |
| Child Questionnaire - Long Form |
Form and Instruction | Modified | Repair queued |
| Adult Questionnaire |
Form and Instruction | Modified | Repair queued |
| Blood Draw and Urine Collection |
Form and Instruction | Modified | Repair queued |
| Body and Blood Pressure Measures |
Form and Instruction | Modified | Repair queued |
| Medication List |
Form and Instruction | Modified | Repair queued |
| Update Contact Information |
Form and Instruction | Modified | Repair queued |
| Appointment Reminder |
Form and Instruction | Modified | Repair queued |
| Eligibility Screening |
Form and Instruction | Modified | Repair queued |
 0 - MSS protocol_Clean 2021-11-16.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| M_Att12_MnlPrcdres_2020-08-31.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| M_Att09_ApptTrckng_20201110.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| M_Att07b_InfrmdCnsnts_2021-05-18.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| M_Att07a_ApptCard_202011010.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| M_Att22a ATSDR PFAS Factsheet.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| 1 - SSB MSS 2023.docx |
Supporting Statement B | Uploaded 2023-05-11 | Repair queued |
| 1 - SSA MSS 20230426_final.docx |
Supporting Statement A | Uploaded 2023-05-15 | Repair queued |
| M_Att22_PFASChemReport_20211116.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| M_Att21_ClinicalTestResultsReport_20211116.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| M_Att20b_LetterRprtCriticalValue_20191212.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| M_Att20a_AdvncClinicalTestReportTrackingForm_20191212.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| M_Att20_AdvReportScriptClinicalTests_20191212.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| M_Att19_BodyBloodPressMsReport_20191212.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| M_Att18a_NBT - TimeEstAgeinYears_20191212.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| M_Att07c_StudyFactSheet_20191212_passback_CLEAN.docx |
Supplementary Document | Uploaded 2023-05-12 | Missing upstream |
| M_Att06_RecrTrackingForm_20191212.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| M_Att05_Multi-siteStudyRecrtmMaterials_20191212.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| M_Att03_JustificationSampleSizeCalcs 20191212.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| M_Att02_BiochemAnalPlanChildrenAdults 20211116.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| M_Att01_InvestigatorsKeyPersonnel_20191212.docx |
Supplementary Document | Uploaded 2023-05-12 | Repair queued |
| 1 - AppndxG Data Sharing and Disclosure Review (Multi-site Study) 20190725.docx |
Supplementary Document | Uploaded 2023-05-11 | Repair queued |
| 1 - AppndxF IRB Approval Memo.docx |
Supplementary Document | Uploaded 2023-05-11 | Repair queued |
 1 - AppndxE Privacy Impact Assessment 20230425signed.pdf |
Supplementary Document | Uploaded 2023-05-11 | Repair queued |
| 1 - AppndxD Pease_Feasibility_Assessment_November-2017_508.pdf |
Supplementary Document | Uploaded 2023-05-11 | Missing upstream |
| 1 - AppndxC NOFO No. CDC-RFA-TS-19-002 rev 20190531.pdf |
Supplementary Document | Uploaded 2023-05-11 | Repair queued |
| 1 - AppndxB 60D FRN.pdf |
Supplementary Document | Uploaded 2023-05-11 | Missing upstream |
| 1 - AppndxA Authorizing Legislation Multi-site Study.docx |
Supplementary Document | Uploaded 2023-05-11 | Missing upstream |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 242013 |  Drinking Water Information Collection (Environmental Protection Agencies) |
Form and Instruction | Unchanged | |
| 242012 | Drinking Water Information Collection (Public Water Purveyors) |
Form and Instruction | Unchanged | |
| 239069 | Child School Record Abstraction |
Form and Instruction | Modified | |
| 239068 | Request for Child School Record Abstraction |
Other-Letter of Request to School Administrator with Study Infor | Modified | |
| 239067 | Medical Record Abstraction - Child |
Form and Instruction | Modified | |
| 239066 | Medical Record Abstraction - Adult |
Form and Instruction | Modified | |
| 239065 | Request for Medical Record Abstraction |
Other-Letter of Request to Provider with Study Information | Modified | |
| 239061 | Child Neurobehavioral Test Battery |
Form and Instruction | Modified | |
| 239060 | Parent Neurobehavioral Test Battery |
Form and Instruction | Modified | |
| 239059 | Child Questionnaire - Short Form |
Form and Instruction | Modified | |
| 239058 | Child Questionnaire - Long Form |
Form and Instruction | Modified | |
| 239057 | Adult Questionnaire |
Form and Instruction | Modified | |
| 239056 | Blood Draw and Urine Collection |
Form and Instruction | Modified | |
| 239053 | Body and Blood Pressure Measures |
Form and Instruction | Modified | |
| 239052 | Medication List |
Form and Instruction | Modified | |
| 239051 | Update Contact Information |
Form and Instruction | Modified | |
| 239050 | Appointment Reminder |
Form and Instruction | Modified | |
| 239035 | Eligibility Screening |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/TSDR |
| OMB Control No | 0923-0063 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202010-0923-002 |
| Agency Tracking No | 0923-0063 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |