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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:
0923-0059
ICR Reference No:
201811-0923-001
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
HHS/TSDR
Agency Tracking No:
0923-18AJK
Title:
Per- or Polyfluoroalkyl Substances Exposure Assessments (PFAS EAs)
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
06/28/2019
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/29/2018
Terms of Clearance:
We appreciate CDC/ATSDR's agreement to the following terms of clearance: Prior to initiating collection at any future sites, ATSDR will provide a detailed site selection supplement similar to the current site supplement but specific to additional study sites for review and approval. Provided that the methodology and data collection are consistent with the approved exposure assessment protocol, the new sites may be included in the package through a non-substantive change request. ATSDR will issue no individual results reports until completion of the interagency scientific review and OMB approves the content and uses of the relevant communication materials.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2022
36 Months From Approved
Responses
8,551
0
0
Time Burden (Hours)
2,131
0
0
Cost Burden (Dollars)
33,029
0
0
Abstract:
This information collection addresses the requirements for completing exposure assessments (EAs) for PFAS authorized in Section 8006 of the Consolidated Appropriations Act, 2018. ATSDR/NCEH will use statistical methods to recruit respondents at a minimum of eight current or former domestic military installations known to have PFAS contamination in water sources. ATSDR will collect biological and environmental samples to evaluate exposure.
Authorizing Statute(s):
US Code:
42 USC 9604
Name of Law: CERCLA
PL:
Pub.L. 115 - 141 8006
Name of Law: Consolidated Appropriations Act
US Code:
42 USC 301
Name of Law: PHSA
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:
83 FR 34135
07/19/2018
30-day Notice:
Federal Register Citation:
Citation Date:
83 FR 60867
11/27/2018
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
Adult Consent
NA
Adult Consent
Adult Exposure Assessment Questionnaire
NA
Adult Exposure Assessment
Child Assent
NA
Assent Form for Minors
Community Event Evaluation Survey
NA
PFAS Exposure Assessment Community Event Evaluation
EA Participants (All Ages) - Biological Testing Tracking
NA
FAS EA Biological Testing Tracking Form
Environmental Sample Collection Form
NA
Environmental Sampling Collection Form
Environmental Sampling Consent
NA
Consent for Environmental Sampling
Exposure Questionnaire for Biological Testing - Child Completed
NA
Exposure Assessment Child
Exposure Questionnaire for Biological Testing - Parent Proxy
NA
Exposure Assessment Child
Household Eligibility Screener
NA
Household Eligibility Screener
Household Recruitment Script for Environmental Sampling
NA
Household Recruitment Script for Environmental Sampling
Parental Permission
NA
Parental Permission Form
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
8,551
0
0
8,551
0
0
Annual Time Burden (Hours)
2,131
0
0
2,131
0
0
Annual Cost Burden (Dollars)
33,029
0
0
33,029
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
This is a new ICR.
Annual Cost to Federal Government:
$3,500,000
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.
Yes
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:
Shari Steinberg 404 639-4942 shari.steinberg@cdc.hhs.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:
11/29/2018
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