OMB control number

Biomonitoring of Great Lakes Populations Program III

OMB 0923-0056 · HHS/TSDR.

OMB 0923-0056

The goal of the Biomonitoring of Great Lakes Populations Program III (0923-0056) is to evaluate body burden levels of legacy contaminants and chemicals of emerging concern in susceptible Great Lakes populations in Milwaukee and the surrounding southeastern area of Wisconsin. Findings from the biomonitoring study will be used to inform participants and other community stakeholders about ways to maximize benefits and minimize risks while consuming locally caught fish in the Great Lakes basin and guide public health action to protect Great Lakes populations from potential exposure to harmful chemicals. The purpose of this Non-Substantive Change Request is to expand the recruitment boundary of the waterbodies due to recruitment challenges experienced by the Wisconsin DHS, These changes result in small changes to a number of Information Collection Instruments and a slight increase in Burden Hours, however the overall scope and direction of the package has not changed.

The latest form for Biomonitoring of Great Lakes Populations Program III expires 2020-07-31 and is listed under ICR 201801-0923-002.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form 0923-0056 Updated Questions on Fish Consumption - Licensed Anglers	Form and Instruction
Follow-Up Survey - Burmese Immigrants and Descendants	Form and Instruction
Network Size Questions - Burmese Immigrants and Descendants	Form and Instruction
Form 0923-0056 Clinic Visit and Body Measurements - Burmese Immigrants and Descendants	Form and Instruction
Form 0923-0056 Study Questionnaire - Burmese Immigrants and Descendants	Form and Instruction
Contact Information Form - Burmese Immigrants and Descendants	Form and Instruction
Form 0923-0056 Eligibility Screening Survey - Burmese Immigrants and Descendants	Form and Instruction
Follow-Up Survey - Licensed Anglers	Form and Instruction
Clinic Visit Checklist and Body Measurements - Licensed Anglers	Form and Instruction
Form 0923-0056 Study Questionnaire - Licensed Anglers - Screenshot	Form and Instruction
Form 0923-0056 Study Questionnaire - Licensed Anglers - Paper	Form and Instruction
Form 0923-0056 Eligibility Screening Survey - Licensed Anglers - Screenshots	Form and Instruction
Form 0923-0056 Eligibility Screening Survey - Licensed Anglers - Paper	Form and Instruction
8c.RDS_Coupon_Burm_20180111_clean.pdf	Supplementary Document
5a.Recruitment Mailings 20180111_clean.pdf	Supplementary Document
4b.Map Waterbody of Interest_20180111__clean.docx	Supplementary Document
4a.ProgramOverview 20180109 clean.docx	Supplementary Document
6b.Consent_Burm_20180111_clean.docx	Supplementary Document
6a.Consent_LicAng_20180111_clean.docx	Supplementary Document
5e.PhoneScripts_LicAng 20170111_clean.docx	Supplementary Document
0923-0056 Change Request Justification and crosswalk table 20180110.docx	Justification for No Material/Nonsubstantive Change
0923-0056 Change Request Justification and crosswalk table attm5b.docx	Justification for No Material/Nonsubstantive Change
0923-0056 Change Request Justification and crosswalk table.docx	Justification for No Material/Nonsubstantive Change
5f.Appointment reminder letters revised.docx	Supplementary Document
5a.RecruitmentManterial invite letter revised.docx	Supplementary Document
12b. WI_ResearchDetermination.pdf	Supplementary Document
12a.ATSDR_ResearchDetermination_GL3.pdf	Supplementary Document
11.LabSOPcomb_metal_PCB_PFC_PAH.pdf	Supplementary Document
10b.ResultsPacket.docx	Supplementary Document
10a.EarlyResults.doc	Supplementary Document
8d.GiftcardLetter_Burm.docx	Supplementary Document
5a.RecruitmentMaterials.pdf	Supplementary Document
3.PublicCommentResponse.docx	Supplementary Document
2.60dayFederalRegisterNotice.pdf	Supplementary Document
1.AuthLegislation ATSDR.docx	Supplementary Document
SSB GL3 20180110 clean.docx	Supporting Statement B
SSA GL3 20180109 clean.docx	Supporting Statement A
Updated Questions on Fish Consumption - Licensed Anglers	Form and Instruction
Follow-Up Survey - Burmese Immigrants and Descendants	Form and Instruction
Network Size Questions - Burmese Immigrants and Descendants	Form and Instruction
Clinic Visit and Body Measurements - Burmese Immigrants and Descendants	Form and Instruction
Study Questionnaire - Burmese Immigrants and Descendants	Form and Instruction
Contact Information Form - Burmese Immigrants and Descendants	Form and Instruction
Eligibility Screening Survey - Burmese Immigrants and Descendants	Form and Instruction
Follow-Up Survey - Licensed Anglers	Form and Instruction
Clinic Visit Checklist and Body Measurements - Licensed Anglers	Form and Instruction
Study Questionnaire - Licensed Anglers - Screenshot	Form and Instruction
Study Questionnaire - Licensed Anglers - Paper	Form and Instruction
Eligibility Screening Survey - Licensed Anglers - Screenshots	Form and Instruction
Eligibility Screening Survey - Licensed Anglers - Paper	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
201801-0923-002	No material or nonsubstantive change to a currently approved collection	2018-01-17	Approved without change
201710-0923-001	No material or nonsubstantive change to a currently approved collection	2017-11-02	Approved without change
201707-0923-001	No material or nonsubstantive change to a currently approved collection	2017-07-21	Approved without change
201703-0923-001	New collection (Request for a new OMB Control Number)	2017-04-12	Approved without change

OMB Details

Eligibility Screening Survey - Licensed Anglers - Paper

Federal Enterprise Architecture: Health - Public Health Monitoring

Information collection instruments
Form	Name	Electronic access	Type
Form 0923-0056	Eligibility Screening Survey for Licensed Anglers (Paper) 16JAN2018	NA	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.