Justification for Non-Substantive Change

Justification for Nonmaterial/Nonsubstantive Change Request

Request Date: August 1, 2016

Title: “Collections Related to Synthetic Turf Fields with Crumb Rubber Infill”

OMB Control Number: 0923-0054 (expiration date 01/31/2017)

This is a nonmaterial/nonsubstantive change request. ATSDR received approval for this emergency information collection request (ICR) on 07/22/2016, with changes.

Subsequently, ATSDR submitted the OMB requested amendments to the protocol (No. 6881), supporting information, and forms to the CDC Institutional Review Board, which was approved on 07/29/2016. The CDC IRB, in its review, requested a few minor changes for consistency. The summary of the IRB-approved amendments is found in the new Attachment 8 (CDC IRB Approval Memo).

Attachment 4. Activity 1 Forms and Supporting Documents

Attachment 4a. Tire Recycling Plant Fact Sheet

Attachment 4c. Tire Recycling Plant Sample Collection Agreement Form

Attachment 4e. Synthetic Turf Field Facility Fact Sheet

Attachment 4g. Synthetic Turf Field Facility Participation Agreement Form

Attachment 5. Activities 2 and 3 Forms and Supporting Documents

Attachment 5a. Field User Fact Sheet

Attachment 5b. Field User Eligibility Screening Script

Attachment 5c. Activity 2 Consent, Assent, Permission Forms

Attachment 5e. Field User Youth and Child Questionnaire

Attachment 7. Research Protocol

Attachment 8. CDC IRB Approval

ATSDR is submitting the following documents (track changes and clean) for OMB approval: