View Information Collection Request (ICR) Package
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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:
0923-0061
ICR Reference No:
202110-0923-001
Status:
Historical Active
Previous ICR Reference No:
202008-0923-001
Agency/Subagency:
HHS/TSDR
Agency Tracking No:
0923-0061-22AB
Title:
Human Health Effects of Drinking Water Exposures to Per- and Polyfluoroalkyl Substances (PFAS) at Pease International Tradeport, Portsmouth, NH (The Pease Study)
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:
01/21/2022
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/06/2021
Terms of Clearance:
revious terms continue: Consistent with the Supporting Statement, the statistical power and sampling frame of this proof of concept study limits ATSDR’s ability to detect moderate differences (between exposed and nonexposed individuals) in many of health conditions queried in this collection. Approval for the collection of information about conditions for which there is not adequate statistical power is provided specifically for the purposes of evaluating the study procedures, methods, and hypotheses for a future multi-site study. Approval is provided contingent upon a commitment to investigate other contributing environmental factors when associations or trends are observed between PFAS exposure and health conditions. Approval is also provided contingent upon a commitment to work with the National Center for Health Statistics on disclosure review procedures and include a member of NCHS’s disclosure review board for NHANES on the PEAS disclosure review board.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2022
08/31/2022
08/31/2022
Responses
5,852
0
5,852
Time Burden (Hours)
1,454
0
1,454
Cost Burden (Dollars)
42,227
0
42,227
Abstract:
The Pease Study will serve as a proof-of-concept model for a multi-site study of PFAS health effects. The existence of a large body of state and local environmental monitoring and population blood testing data makes the Pease community in Portsmouth, NH particularly suitable as ATSDR’s initial PFAS research study site. The main goals of the research study are to: 1) evaluate the study procedures and methods to identify any changes to the design or protocol that need to be made before embarking on a multi-site study; and 2) examine associations between a limited number of health outcomes for which statistical power is adequate and measured and historically reconstructed serum levels of PFAS (e.g., lipids, renal function and kidney disease, thyroid hormones and disease, liver function and disease, glycemic parameters and diabetes, as well as immune response and function in both children and adults). This change request reflects minor modifications to the currently approved information collection request (ICR) but no changes to the burden or instruments.
Authorizing Statute(s):
PL:
Pub.L. 115 - 141 8006
Name of Law: Consolidated Appropriations Act
US Code:
42 USC 9604
Name of Law: CERCLA
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 43685
08/27/2018
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR 3449
02/12/2019
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
18
IC Title
Form No.
Form Name
Adult Questionnaire
none
Adult Questionnaire
Appointment Reminder Telephone Script
0923-0061
Appointment Reminder Telephone Script
Blood Draw and Urine Collection Form
none
Blood Draw and Urine Collection
Body and Blood Pressure Measures Form
none
Body and Blood Pressure Measures
Child Neurobehavioral Test Battery
Child Questionnaire - Long Form
none
Child Questionnaire - Long Form
Child Questionnaire - Short Form
none
Child Questionnaire - Short Form
Child School Record Abstraction
none
Child School Record Abstraction
Medical Record Abstraction - Adult
none
Medical Record Abstraction -Adult
Medical Record Abstraction - Child
none
Medical Record Abstraction - Child
Medication List
none
Medication List
Parent Neurobehavioral Test Battery
Request for Child School Record Abstraction
Request for Medical Record Abstraction
Update Contact Information Hardcopy Form
none
Update Contact Hardcopy Form
Wave One Elligibility Screening Script
0923-0061
Wave One Eligibility Screening Script
Wave Three Eligibility Screening Script
0923-0061
Wave Three Eligibility Script
Wave Two Eligibility Screening Script
0923-0061
Wave Two Eligibility Script
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
5,852
5,852
0
0
0
0
Annual Time Burden (Hours)
1,454
1,454
0
0
0
0
Annual Cost Burden (Dollars)
42,227
42,227
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:
This is a resubmission of a new ICR.
Annual Cost to Federal Government:
$1,912,122
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?
Yes
Agency Contact:
Kevin Joyce 404 639-1944 kdj7@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:
10/06/2021
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