Privacy Act Statement

Appendix B1 Privacy Act Statement

PRIVACY ACT STATEMENT

FOR

PFAS EXPOSURE ASSESSMENT – BIOLOGICAL AND ENVIRONMENTAL SAMPLING

This statement provides the notice required by the Privacy Act of 1974 (5 USC § 552a(e)(3)).

• Authority: The Agency for Toxic Substances and Disease Registry (ATSDR) has the authority to collect this information under Section 8006 of the Consolidated Appropriations Act of 2018. ATSDR also conducts exposure assessments under the ‘‘Comprehensive Environmental Response, Compensation, and Liability Act of 1980’’ (CERCLA) as amended by ‘‘Superfund Amendments and Reauthorization Act of 1986’’ (SARA) (42 U.S.C. 9601, 9604).

• Purpose: ATSDR is conducting this assessment to study your exposure to per- and polyfluoroalkyl substances (PFAS) from drinking water. ATSDR is collecting this information on you or your child for:

  • Adult consent, parental permission, and child assent to participate in questionnaires, and blood and urine collections.

  • Collection of drinking water and dust samples in a subset of households.

  • Sending your, your child’s, or your household results back to you.

• Routine Uses:

  • ATSDR will share these records with the National Center for Environmental Health (NCEH). NCEH may provide investigation or support staff, laboratory and statistical analysis, etc.

  • ATSDR may disclose these records to its contractors to locate individuals exposed or potentially exposed to PFAS, and to conduct interviews and other assessment activities. The contractor must comply with the requirements of the Privacy Act to protect your or your child’s records.

  • Other routine uses as described in System of Records Notice (SORN) No. 09-19-0001 - ‘‘Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances.” See https://www.gpo.gov/fdsys/pkg/FR-2011-01-25/pdf/2010-33004.pdf.

• Disclosure: Providing this information is voluntary. ATSDR needs this information for you or your child to take part in the study. ATSDR may not include incomplete records in the data analysis. ATSDR needs up-to-date contact information to send your or your child’s study results.