View Information Collection Request (ICR) Package
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View Information Collection (IC) List
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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:
0923-0063
ICR Reference No:
201908-0923-002
Status:
Historical Inactive
Previous ICR Reference No:
Agency/Subagency:
HHS/TSDR
Agency Tracking No:
0923-19ACF
Title:
Human Health Effects of Drinking Water Exposures to Per- and Polyfluoroalkyl Substances (PFAS): A Multi-site Cross-sectional Study
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:
Withdrawn
Conclusion Date:
01/03/2020
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/23/2019
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
36 Months From Approved
Responses
0
0
0
Time Burden (Hours)
0
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
The main goal of this cross-sectional multi-site PFAS study is to evaluate associations between measured and reconstructed historic serum levels of PFAS including PFOA, PFOS, and PFHxS, and selected health outcomes. ATSDR seeks to enroll at least 8,000 participants (6,000 adults and 2,000 children) from communities exposed to PFAS-contaminated drinking water over the first three years of the five-year cooperative agreement program.
Authorizing Statute(s):
PL:
Pub.L. 115 - 32 315(a)
Name of Law: John S. McCain National Defense Authorization Act for FY 2019
PL:
Pub.L. 115 - 91 316(a)
Name of Law: 2018 National Defense Authorization Act
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:
84 FR 16857
04/23/2019
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR 70544
12/23/2019
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
16
IC Title
Form No.
Form Name
Adult Questionnaire
n/a
Multi-site Study Adult Questionnaire
Appointment Reminder
n/a
Appointment Reminder Telephone Script
Blood Draw and Urine Collection
n/a
Blood Draw and Urine Collection Form
Body and Blood Pressure Measures
n/a
Body and Blood Pressure Measures Form
Child Neurobehavioral Test Battery
n/a
Child/Parent Neurobehavioral Test Battery
Child Questionnaire - Long Form
n/a
Multi-site Study Child Questionnaire – Long Form
Child Questionnaire - Short Form
n/a
Multi-site Study Child Questionnaire – Short Form
Child School Record Abstraction
n/a
Multi-site Study Child School Record Abstraction Form
Eligibility Screening
n/a
Eligibility Screening Script
Medical Record Abstraction - Adult
n/a
Multi-site Study Medical Record Abstraction Form - Adult
Medical Record Abstraction - Child
n/a
Multi-site Study Medical Record Abstraction Form - Child
Medication List
n/a
Medication List
Parent Neurobehavioral Test Battery
n/a
Child/Parent Neurobehavioral Test Battery
Request for Child School Record Abstraction
Request for Medical Record Abstraction
Update Contact Information
n/a
Update Contact Information Hardcopy Form
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 information collection request.
Annual Cost to Federal Government:
$7,379,582
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:
Renita Macaluso 770 488-6458 arp5@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:
12/23/2019
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