Biomonitoring of Great Lakes Populations Program

Forms and Documents

Document Name	Status
NY Burmese Network Questions Form	New
NY Burmese Questionnaire Form	New
NY Burmese Consent Form	New
NY Burmese Screener Form	New
New York Questionnaire Form	New
New York Consent Form	New
New York Responder Script Form	New
New York Non-responder Script Form	New
New York On-line Screener Form	New
New York Mail-in Screener Form	New
Minnesota Participation Record Form	New
Minnesota Clinic Visit Form	New
Minnesota Participant Questionnaire Form	New
Minnesota Contact Information Form	New
Minnesota Consent Form	New
Minnesota Refusal Questions Form	New
Minnesota Recruitment Script Form	New
Michigan Biomonitoring Questionnaire Form	New
Michigan Consent Form	New
Michigan Scheduling Questionnaire Form	New
Michigan Screener Form	New
Great Lakes_SS_B_2.15.2012.doc Supporting Statement B	2012-02-23
2-GreatLakes_SSA_Refs.docx Supplementary Document	2012-02-27
Att9 Non-research.docx Supplementary Document	2012-02-23
Att8_Outside_Consults.docx Supplementary Document	2012-02-23
Att7_ChemAnalytes.docx Supplementary Document	2012-02-23
Att3_StudyAreas.docx Supplementary Document	2012-02-23
Att1_AuthLegsl.docx Supplementary Document	2012-02-23
Att6_NY_ICFlow.docx Supplementary Document	2012-02-27
Att5_MN_ICFlow.docx Supplementary Document	2012-02-27
Att4_MI_ICFlow.docx Supplementary Document	2012-02-27
GreatLakes_SuppStmt_A_2.22.12.docx Supporting Statement A	2012-02-23

IC Document Collections

IC ID	Document Title	Status
201475	NY Burmese Network Questions Form	New
201474	NY Burmese Questionnaire Form	New
201473	NY Burmese Consent Form	New
201472	NY Burmese Screener Form	New
201471	New York Questionnaire Form	New
201470	New York Consent Form	New
201469	New York Responder Script Form	New
201468	New York Non-responder Script Form	New
201467	New York On-line Screener Form	New
201466	New York Mail-in Screener Form	New
201465	Minnesota Participation Record Form	New
201464	Minnesota Clinic Visit Form	New
201463	Minnesota Participant Questionnaire Form	New
201462	Minnesota Contact Information Form	New
201461	Minnesota Consent Form	New
201460	Minnesota Refusal Questions Form	New
201459	Minnesota Recruitment Script Form	New
201458	Michigan Biomonitoring Questionnaire Form	New
201457	Michigan Consent Form	New
201456	Michigan Scheduling Questionnaire Form	New
201455	Michigan Screener Form	New

ICR Details

OMB Control No: 0923-0044	ICR Reference No: 201203-0923-001
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/TSDR	Agency Tracking No:
Title: Biomonitoring of Great Lakes Populations Program
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: 09/26/2012
	Date Received in OIRA: 03/07/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		24 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The FY 2010-14 Great Lakes Restoration Initiative (GLRI) was established to protect, restore, and maintain the Great Lakes ecosystem by a task force of 16 federal agencies led by the EPA and over $750,000 was appropriated. ATSDR's Great Lakes Biomonitoring Program provides assessment of human exposure to contaminants concurrent with GLRI activities. ATSDR awarded fund to 3 state health departments to study exposures in their jurisdictions.

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Authorizing Statute(s): US Code: 42 USC 9604 Name of Law: CERCLA
   US Code: 42 USC 9626 Name of Law: Superfund Amendments and Reauthorization Act of 1986
   PL: Pub.L. 111 - 88 1 Name of Law: Dept. of Interior, Environment, and Related Agencies Appropriations Act of 2010
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 68462	11/04/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 12594	03/01/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 21

IC Title	Form No.	Form Name
Minnesota Participant Questionnaire	none	Minnesota Participant Questionnaire
Michigan Screener	none	Michigan screening questionnaire
Michigan Scheduling Questionnaire	none	Michigan Scheduling Questionnaire
Michigan Consent	none	Michigan Consent
Michigan Biomonitoring Questionnaire	none	Michigan Biomonitoring Questionnaire
Minnesota Recruitment Script	none	Minnesota Recruitment Script
Minnesota Refusal Questions	none	Minnesota Refusal Questions
Minnesota Consent	none	Minnesota Consent
Minnesota Contact Information	none	Minnesota Contact Information
Minnesota Clinic Visit	none	Minnesota Clinic Visit
Minnesota Participation Record	none	Minnesota Participation Record
New York Mail-in Screener	none	New York Mail-in Screener
New York On-line Screener	none	New York On-line Screener
New York Non-responder Script	none	New York Non-responder Script
New York Responder Script	none	New York Responder Script
New York Consent	none	New York Consent
New York Questionnaire	none	New York Questionnaire
NY Burmese Screener	none	New York Burmese Screener
NY Burmese Consent	none	NY Burmese Consent
NY Burmese Questionnaire	none	NY Burmese Questionnaire
NY Burmese Network Questions	none	NY Burmese Network Questions

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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.

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Annual Cost to Federal Government: $3,800,000

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? 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

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Common Form ICR:  No

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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: 03/07/2012

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