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:
202305-0923-001
Status:
Historical Active
Previous ICR Reference No:
202010-0923-002
Agency/Subagency:
HHS/TSDR
Agency Tracking No:
0923-0063
Title:
[ATSDR] Human Health Effects of Drinking Water Exposures to Per- and Polyfluoroalkyl Substances (PFAS): A Multi-site Cross-sectional Study
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
07/06/2023
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/16/2023
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
07/31/2026
36 Months From Approved
07/31/2023
Responses
35,121
0
35,121
Time Burden (Hours)
8,149
0
8,149
Cost Burden (Dollars)
233,544
0
233,544
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. This revision request includes minor changes to the study protocol and reports.
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:
88 FR 1584
01/11/2023
30-day Notice:
Federal Register Citation:
Citation Date:
88 FR 30747
05/12/2023
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
18
IC Title
Form No.
Form Name
Adult Questionnaire
none
Adult questionnaire
Appointment Reminder
none
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
none
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
Drinking Water Information Collection (Environmental Protection Agencies)
n/a
Water Information Collection Form for Environmental Protection Agencies
Drinking Water Information Collection (Public Water Purveyors)
n/a
Drinking Water Information Collection Form for Public Water Purveyors
Eligibility Screening
none
Eligibility screener
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
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
35,121
35,121
0
0
0
0
Annual Time Burden (Hours)
8,149
8,149
0
0
0
0
Annual Cost Burden (Dollars)
233,544
233,544
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:
$15,285,872
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?
No
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:
05/16/2023
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