View Information Collection Request (ICR) Package
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Brief and OIRA conclusion
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Legal Statutes
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FR Notices/Comments
IC List
Burden
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Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0923-0056
ICR Reference No:
201707-0923-001
Status:
Historical Active
Previous ICR Reference No:
201703-0923-001
Agency/Subagency:
HHS/TSDR
Agency Tracking No:
17AXL
Title:
Biomonitoring of Great Lakes Populations Program III
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
07/25/2017
Retrieve Notice of Action (NOA)
Date Received in OIRA:
07/21/2017
Terms of Clearance:
Previous terms continue: Approved consistent with the understanding that the core program objective is to provide a current ‘snap shot’ of human exposure levels among susceptible subpopulations living around the Milwaukee AOC. This surveillance project will not investigate health outcomes or biological effects from such exposures. The biomonitoring results will not be generalized beyond the selected AOC and the defined subpopulations under study. The design does not support the ability to draw conclusions about the statistical significance of differences between either the populations being studies or with data from nationally representative populations (e.g., NHANES), as the underlying assumptions in all of these samples are very different.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
07/31/2020
07/31/2020
07/31/2020
Responses
731
0
731
Time Burden (Hours)
227
0
227
Cost Burden (Dollars)
0
0
0
Abstract:
The purpose of this request is to make non-substantive changes to the recruitment letter/postcard (attachment 5a), appointment reminder letters (attachment 5f), and clinic visit checklists (attachments 8a and 8b) per suggestions from WI DHS external information approval reviewers and field clinic.
Authorizing Statute(s):
US Code:
42 USC 9604
Name of Law: CERCLA / SARA
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:
82 FR 124
01/03/2017
30-day Notice:
Federal Register Citation:
Citation Date:
82 FR 16832
04/06/2017
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
12
IC Title
Form No.
Form Name
Clinic Visit Checklist and Body Measurements - Licensed Anglers
NA
Clinic Visit Checklist and Body Measurements - Licensed Anglers
Clinic Visit and Body Measurements - Burmese Immigrants and Descendants
0923-0056
Clinic Visit Checklist and Body Measurements - Burmese Immigrants and their Descendants
Contact Information Form - Burmese Immigrants and Descendants
NA
Contact Information Form for Burmese Immigrants and their Descendants
Eligibility Screening Survey - Burmese Immigrants and Descendants
NA
Eligibility Screening Survey for Burmese Immigrants and their Descendants
Eligibility Screening Survey - Licensed Anglers - Paper
NA
Eligibility Screening Survey for Licensed Anglers - Paper
Eligibility Screening Survey - Licensed Anglers - Screenshots
NA
Eligibility Screening Survey for Licensed Anglers - Screenshot
Follow-Up Survey - Burmese Immigrants and Descendants
NA
Follow-Up Survey - Burmese Immigrants and their Descendants
Follow-Up Survey - Licensed Anglers
NA
Follow-Up Survey for Licensed Anglers
Network Size Questions - Burmese Immigrants and Descendants
NA
Network Size Questions for Respondent-driven Sampling - Burmese Immigrants and their Descendants
Study Questionnaire - Burmese Immigrants and Descendants
NA
Study Questionnaire - Burmese Immigrants and their Descendants
Study Questionnaire - Licensed Anglers - Paper
NA
Study Questionnaire for Licensed Anglers - Paper
Study Questionnaire - Licensed Anglers - Screenshot
NA
Study Questionnaire for Licensed Anglers - Screenshot
ICR Summary 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
731
731
0
0
0
0
Annual Time Burden (Hours)
227
227
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:
$633,000
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
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?
Uncollected
Agency Contact:
Thelma Sims 404 639-4771 tfs4@cdc.gov
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:
07/21/2017
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