




          Appendix A
          Draft National Fish Advisory Program Evaluation

                                                            OMB Control Number 2040-0226 Approval Expires XX/XX/XX

                      United States Environmental Protection Agency 
                        Voluntary Information Collection for the 
                        National Fish Advisory Program Evaluation
                                             
       EPA is collecting the following information from states and tribes on a voluntary basis, once during the three-year period of this ICR. Specifically, EPA is interested in fish program information for the National Fish Advisory Program Evaluation, from state or tribal agencies responsible for issuing noncommercial (sportfishing/subsistence) fish/shellfish advisories or closures for chemical contamination in fish and shellfish. 
       
       EPA aims to advance efforts to support equity and environmental justice in fish advisory programs by ensuring that recreational and subsistence fishers and other underserved populations are protected from consumption of contaminated fish. EPA will analyze the collected information to determine what science, guidance, technical assistance, and nationwide information are needed to help state and tribes have equitable and effective fish advisory programs. In addition, EPA will also use the information provided to facilitate information sharing and to ensure guidance documents are useful and technically accurate.
       
       EPA greatly appreciates your assistance and thanks you for your continued support of USEPA's National Fish Program. For questions regarding this program evaluation, please contact CDR Samantha Fontenelle at fontenelle.samantha@epa.gov.

      
      
      Sara Hisel-McCoy
      Director, Standards and Health Protection Division
      Office of Water, Office of Science and Technology 
      U.S. Environmental Protection Agency 



       Respondent's Agency name
 Respondent's Agency address
 Respondent's Agency fish advisory contact
  Respondent's Contact's e-mail address
  Respondent's Contact's phone number 
       
	 
      
 Fish Tissue Monitoring Program

 Did your state or tribal agency conduct routine monitoring in the last three years to obtain information about the concentrations of contaminants in fish tissue for assessing human health risks?
           __ Yes	__ No	__Not applicable

            What kind of data does your state or tribal agency collect to evaluate contaminant levels in fish? (Please check all that apply.)
       __	Captures fish and sends tissues to a lab to determine contaminant concentrations
       __	Monitors water quality and uses data to estimate contaminant concentrations in fish
       __	Monitors sediments and uses data to estimate contaminant concentrations in fish
       __	Other methods (please specify) 	
       __	Not applicable

            How does your state or tribe conduct monitoring of contaminants in fish tissue for fish advisories? (Please check all that apply)
       __	Conducts one-time, nonrecurring or special surveys in particular fishing areas, watersheds, or basins
       __	Monitors the same fishing areas, watersheds, or basins at regular intervals
       __	Other methods (please specify) 	
       __	Not applicable

            In the last three years, please estimate the number of stations from which your state or tribal agency collected fish tissue that was analyzed for contaminants and/or was used for the fish advisory program.
       __	0 stations	__ 31-50 stations
       __	1-10 stations	__ 51-100 stations
       __	11-20 stations	__ >100 stations
       __	21-30 stations	__ Not applicable
            How frequently does your state or tribe typically resample fish from waterbodies where advisories are in effect?
       __	Every year
       __	Every 2 years
       __	Every 3 years
       __	Every 4 years
       __	Every 5 years
       __	Every 6 to 10 years
       __	On an as-needed basis (no set schedule)
       __	Other (please specify) 	
       __	Not applicable
             In approximately how many waterbodies was fish tissue monitoring conducted within your state or tribe in the last three years?
       __	1-10 waterbodies	__	21-30 waterbodies
       __	11-20 waterbodies	__	31-40 waterbodies
       __	>40 (specify number) (please specify) 	
       __	Not applicable

            Please check how your state or tribe determines which sites to monitor contaminants in fish tissue (Please check all that apply)
__
  Accessibility of site
                                                                             __
 Fixed-station sites
__
  Area of concern
                                                                             __
 High pollution potential at the site
__
  Citizen or Agency request
                                                                             __
 Major fishery resource
__ __

  Degree of angling pressure the site receives
  Other method (please specify) 	
                                                                             __
 Randomly selected sites
__  Not Applicable
 
 
 


__
  Accessibility of site
                                                                             __
 Fixed-station sites
__
  Area of concern
                                                                             __
 High pollution potential at the site
__
  Citizen or Agency request
                                                                             __
 Major fishery resource
__ __

  Degree of angling pressure the site receives
  Other method (please specify) 	
                                                                             __
 Randomly selected sites
__  Not Applicable
 
 
 




       
       Answers to questions 8 through 11 should be based on your Agency's evaluation of fish tissue monitoring data. Sediment analysis or water quality monitoring data may be included in your evaluation only if they are used as the basis for determining when an advisory is needed. Note: For these questions, you may need to consult with other individuals in your state or tribal organization.

             How many river, stream, or canal miles were monitored  at least once during the last 3 years specifically for the fish advisory program?
                     miles
           

            How many lake or reservoir acres were monitored at least once during the past 3 years specifically for the fish advisory program?
             	 acres

            How many square miles of estuarine waters were monitored at least once during the past 3 years specifically for the fish advisory program?
                     square miles
           

             How many miles of marine coastline (coastal waters) were monitored at least once during the past 3 years specifically for the fish advisory program?
             	 miles


       Types of Fish Advisories
             Does your state or tribe issue fish consumption advisories advising individuals to restrict fish consumption for a particular waterbody?
           __ Yes	__  No	__	Not applicable

             Does your state or tribe issue fish consumption advisories advising individuals not to consume any fish or any fish of a particular species from a particular waterbody?
            __ Yes	__  No	__	Not applicable

            Fish consumption advisories issued in your state or tribe pertain to: (Please check all that apply)
       __	Specific fish species analyzed by the state (e.g., largemouth bass)
       __	Specified size class(es) for the given species analyzed (e.g., largemouth bass 15-20 inches)
       __	Selected trophic groups (e.g., game fish, bottom feeders, or panfish)
       __	The entire fish community (e.g., all fish)
       __	Certain fish species purchased in stores and restaurants
       __	Other (please specify) 	
       __	Not applicable

            Does your state or tribe issue statewide or regionwide or tribal area-wide "blanket" advisories based on your sampling effort? (A region-wide advisory may be issued for an individual HUC, river drainage basin or portion of the state.)
State or tribe wide:
 __ Yes
  __ No
                                                              __ Not applicable
Regionwide:
 __ Yes
  __ No
                                                              __ Not applicable
            Are there enforceable advisories or bans within your state or tribe (e.g., are fines or citations given for fishing in posted waters)?
           __	Yes	__ No

            Does your state or tribe issue fish and/or shellfish advisories (closures) for microbial contamination (e.g., bacteria or viruses) of a waterbody?
            __ Yes 	__ No  	__ Not applicable
           
 Does your state or tribe also issue fish and/or shellfish advisories (closures) for algal toxin contamination (e.g., cyanotoxins) of a waterbody?
     __ Yes 	__ No  	__ Not applicable
     
       Sample Preparation and Analyses Procedures
            Fish consumption advisories ("no" consumption and/or restricted consumption advisories) issued in your state or tribe are based on the analysis of : (Please check all that apply)
       __  	Fillet samples (skin on) 
       __ 	Fillet samples (skin off) 
       __ 	Muscle plug samples
       __	Whole-fish samples (skin on)
       __	Whole-fish samples (skin off)
       __	Other sample types (please specify)  	
       __	Not applicable

            Does your state or tribe target the collection of particular indicator fish/shellfish species, and on what is this decision based? (Please check all that apply)
       __	State/Tribe does not target collection of indicator species 
       __	State/Tribes targets collection of indicator species based on:
           __	Angler survey data
           __	Availability of the species
           __	Desire to maintain consistency with past collections
           __	EPA target species recommendations based on bioaccumulation potential/trophic groups
           __	Citizen requests
           __	Other reasons (please specify)
           __	Not applicable
           
 Which particular indicator fish species does your state or tribe target for monitoring?
           (Please specify)____________________________________________________________________________
           
            Does your state or tribe collect multiple size classes, by species, and submit these individual size classes for contaminant analyses?
           __	Yes	__  No	__ Not applicable


        Are individual fish samples or composite samples submitted for contaminant analyses in your state or tribe?
       __	Individual fish samples only
       __	Composite samples only
       __	Both individual and composite samples are used
       __	Not applicable

 If individual fish samples are used, how many "individual fish" typically are needed to support an advisory determination in a waterbody?
       __	1 fish
       __	3 fish
       __	5 fish
       __	6 to 10 fish
       __	11 to 20 fish
       __	> 20 fish
       __	Other number (please specify)  	
       __	Not applicable; state uses only composite fish samples
 If composite samples are used, how many "individual fish" typically are combined in each of  state or tribal composite samples for contaminant analysis?
       __	2 fish
       __	3 fish
       __	4 fish
       __	5 fish
       __	Other number (please specify) 	
       __	Not applicable; state uses only individual fish samples
 If composite samples are used, how many composite samples are needed to support an advisory determination in a waterbody?
       __	1 composite sample __	2 composite samples __	3 composite samples
       __	Variable; no set number
       __	Other number (please specify) 	
       __	Not applicable; state uses only individual fish samples

 Assuming your state or tribe finds contaminant levels in fish/shellfish in exceedance of its benchmark or screening level, how many years of sampling are required at a given waterbody before a fish consumption advisory can be issued?
       __	1 year
       __	2 years
       __	3 or more years
       __	Site-specific decision; no set time period established
       __	Other (please specify)  	
       __	Not applicable
            Once an advisory is issued for a specific waterbody, what must occur for the state or tribe to rescind the advisory?
           __	Contaminant levels of the chemical must decline below the benchmark or screening level for at least 1 year 
           __	Contaminant levels of the chemical must decline below the benchmark or screening level for at least 2 years
            __	Contaminant levels of the pollutant must decline below the benchmark or screening level for at least 3 years 
       __	Site-specific decision; no set time period established
       __	Other schedule or procedure (please specify) 	
       __	Not applicable
       
       
 In the last three years, please estimate the number of fish tissue samples that were submitted for chemical analyses by your state or tribal agency?
       __	<20 samples	__   41-50 samples
       __	21-30 samples	__   51-60 samples
       __	31-40 samples	__ >60 samples (please specify number)  	
       __	Not applicable

 What pollutants did your state or tribe screen for in fish tissue samples in the last three years? (Please check all that apply)

       __	Aldrin
       __	Arsenic
       __	Cadmium
       __	Chlordane __	Chlorpyrifos __	Chromium __	DDT and its
           metabolites
       __	Diazinon
    __	Dicofol
    __	Dieldrin
    __	Dioxins/Furans
    __  	Disulfoton 
    __	Endosulfan 
    __ 	Endrin
    __	Ethion
    __	Heptachlor or Heptachlor epoxide
     __	Hexachlorobenzene
     __	Lead
     __	Lindane
     __	Mercury
     __	Methoxychlor
     __	Mirex
     __	Nonachlor __	Oxyfluorfen __	PAHs
  __	PCBs
  __	PFAS 
  __	Pentachloroanisole
  __	Selenium
  __	Terbufos __	Toxaphene __	Tributyltin __	Trifluralin
  __	Other (please specify)


 Of the pollutants listed, which ones are of primary human health concern in your state or tribal waters (specify up to 5 pollutants).

       __	Aldrin
       __	Arsenic
       __	Cadmium
       __	Chlordane __	Chlorpyrifos __	Chromium __	DDT and its
           metabolites
       __	Diazinon
    __	Dicofol
    __	Dieldrin
    __	Dioxins/Furans
    __  	Disulfoton 
    __	Endosulfan 
    __ 	Endrin
    __	Ethion
    __	Heptachlor or Heptachlor epoxide
     __	Hexachlorobenzene
     __	Lead
     __	Lindane
     __	Mercury
     __	Methoxychlor
     __	Mirex
     __	Nonachlor __	Oxyfluorfen __	PAHs
  __	PCBs
  __	PFAS 
  __	Pentachloroanisole
  __	Selenium
  __	Terbufos __	Toxaphene __	Tributyltin __	Trifluralin
  __	Other (please specify)



        If your state or tribe analyzes for PCBs, what specifically is analyzed? (Please check all that apply)
       __	Individual congeners
       __	All 209 congeners
       __	All Aroclor groups
       __	Selected Aroclor groups
       __	A combination of both Aroclors and congeners
       __	Others (please specify) 	
       __	Not applicable
           
 If your state or tribe analyzes for PFAS, which PFAS compound specifically is 
           analyzed? Check all that apply.
	__	Perfluorobutyric acid (PFBA) 
	__	Perfluorobutanesulfonic acid (PFBS) 
    __	Perfluoropentanoic acid (PFPeA)
   __		Perfluorohexanoic acid (PFHxA)
   __		Perfluorohexanesulfonic acid (PFHxS)
   __		Perfluoroheptanoic acid (PFHpA)
   __		Perfluorooctanoic acid (PFOA)
   __		Perfluorooctane sulfonate (PFOS)
   __		Perfluorooctanesulfonamide (PFOSA)
   __		Perfluorononanoic acid (PFNA)
   __		Perfluorodecanoic acid (PFDA)
   __		Perfluoroundecanoic acid (PFUnA)
   __		Perfluorododecanoic acid (PFDoA)
       __	Other (please specify)_____________________________________________________________
   
       State or Tribal Fish Advisory Program Funding
        How many dollars are spent annually in your state or tribe on routine fish tissue field collection activities?
       __	<$1,000	__   $10,000 to $24,999
       __	$1,000 to $4,999	__   $25,000 to $50,000
       __	$5,000 to $9,999	__ >$50,000 (please specify)  	
       __	Not applicable

 What was the funding source for your state or tribal fish tissue collection activities in the last three years ? (Please check all that apply)
       __	State or tribal general funds
       __	State or tribal fishing license revenues
       __	State or tribal sales tax
       __	EPA Section 106 funds 
       __	EPA Section 205j funds 
       __	EPA Region funds
       __	EPA Grant funds
       __	Other (please specify) 	
       __	Not applicable
        How many dollars are spent annually in your state or tribe on laboratory analyses of fish tissue samples?
       __	<$1,000	__   $10,000 to $24,999
       __	$1,000 to $4,999	__   $25,000 to $50,000
       __	$5,000 to $9,999	__ >$50,000 (please specify)  	
       __	Not applicable


 What was the funding source for your state or tribal laboratory analyses of fish tissue samples in the last three years? (Please check all that apply)
       __	State or tribal general funds
       __	State or tribal fishing license revenues
       __	State or tribal sales tax
       __	EPA Section 106 funds 
       __ 	EPA Section 205j funds 
       __ 	EPA Region funds
       __   EPA Grant funds
       __	Other (please specify) 	
       __	Not applicable
 If no funding is currently available, is your state or tribe seeking funding to conduct a fish tissue monitoring and assessment program?
           __ Yes	__  No	__	Not applicable

       Other Uses of State or Tribal Advisory Data
 For your state or tribal biennial 305(b) water quality report, what assignment is made for a waterbody with a fish consumption advisory?
__
 Fully supporting
                                                                             __
  Threatened
__
 Partially supporting
                                                                             __
  Not supporting
__
 No assessments were made
                                                                             __
  Not applicable
 If fish consumption advisories have been issued for waterbodies in your state or tribe, does your state or tribe place these waterbodies on the 303(d) list of impaired waters?
           __ Yes	__	No	__	Not applicable
           
        Is "fish consumption" an assigned designated use for waters in your state or tribe?
           __ Yes	__ No

       Risk Assessment Methodology
 What method(s) does your state or tribe currently use to calculate "carcinogenic" health risks and issue advisories for individuals who consume fish harvested from state or tribal waters?
           (Please specify all current methods used)
       __	EPA Fish Advisory Guidance Document
       __	State or Tribal developed risk assessment methodology
       __	Great Lakes Consortium Protocols and Best Practices for Uniform Fish Advisories
       __	Food and Drug Administration (FDA) action levels
       __	None
       __	Other approach (please specify)  	
       __	Not applicable

 What carcinogenic risk level (i.e., individual risk within an exposed population) does your state or tribe use to issue advisories?
       __	1:10,000 (10-4)
       __	1:100,000 (10[-5])
       __	1:1,000,000(10[-6])
       __	Other (please specify) 	
       __	Not applicable
       
            What source(s) does your state or tribe use to obtain cancer potency factors to help calculate "carcinogenic" health risks? (Please check all that apply)
       __	ATSDR Toxicological Profiles
       __	EPA Fish Advisory Guidance Document
       __	EPA Health Effects Assessment Summary Table (HEAST)
       __	EPA Integrated Risk Information System (IRIS)
       __	Great Lakes Consortium Protocols and Best Practices for Uniform Fish Advisories
       __	Hazardous Substance Data Bank (HSDB)/PubChem 
       __	International Agency for Research on Cancer (IARC) Monographs
       __	Other sources (please specify)  	
       __	Not applicable

 What method(s) does your state or tribe currently use to calculate "noncarcinogenic" benchmarks or screening levels for issuing fish advisories for individuals who consume fish harvested from state or tribal waters? (Please specify all current methods used)
       __	EPA Integrated Risk Information System (IRIS)
       __	EPA Fish Advisory Guidance Document
       __	ATSDR Toxicological Profiles
       __	FDA Action Levels
       __	Great Lakes Consortium Protocols and Best Practices for Uniform Fish Advisories 
       __	Other approach (please specify) 	
       __	Not applicable
       __	None
 If the state or tribe does not calculate its own benchmark or screening levels, what noncarcinogenic benchmark or screening level (i.e., individual risk within an exposed population) does your state use to issue advisories?
       __	Hazard index (please specify if hazard index is >, =, or < 1) 	
       __	FDA action levels
       __	Other (please specify) 	
       __	Not applicable
 What source(s) does your state or tribe use to obtain reference dose to help calculate noncarcinogenic health benchmark or screening level? (Please check all that apply)
       __	ATSDR Toxicological Profiles
       __	EPA Integrated Risk Information System (IRIS)
       __	EPA Health Effects Assessment Summary Table (HEAST)
       __	EPA Fish Advisory Guidance Document
       __	Great Lakes Consortium Protocols and Best Practices for Uniform Fish Advisories
       __	Hazardous Substance Data Bank (HSDB)/PubChem 
       __	Other sources (please specify)  	
       __	Not applicable

            Of all the fish advisories currently in effect in your jurisdiction, including those issued last year and in earlier years, what percentage were issued based on each of these methods?
           (Please write down your best estimate of the percentage for each method)
       ___	% of advisories now in effect were issued using EPA Fish Advisory Guidance document
       __ 	% of advisories now in effect were issued using FDA action levels.
       ___   % of advisories now in effect were issued using state or tribal methods specified in question 42
       ___	% of advisories now in effect were issued using other methods specified in question 42 and 44
       __ 	Not applicable

           What default value does your state or tribe use in the risk assessments as a daily fish consumption rate for recreational fishers?
       __	6.5 g/day
       __	17.5 g/day
       __	22 g/day
          __	32 g/day (a nutritionally y focused fish consumption rate consistent with the Dietary Guidelines for Americans, equivalent to one eight-ounce meal of fish and shellfish per week)
          __	142 g/day  (fish consumption rate for "high consumers" described in the EPA 2000 Human Health Methodology)
       __	175 g/day (fish consumption rate used by EPA and some states for high frequency consumers or subsistence fishers in the Pacific Northwest)
       __ 	Other consumption rates (please specify value in g/day) 	
       __ 	Not applicable

           What default value does your state or tribe use in the risk assessments as a daily fish consumption rate for subsistence or high frequency fish consumers?
       __ 	6.5 g/day
       __ 	17.5 g/day
       __ 	22 g/day
       __ 	32 g/day (a nutritionally focused fish consumption rate consistent with the Dietary Guidelines for Americans, equivalent to one eight-ounce meal of fish and shellfish per week)
       __	142 g/day  (fish consumption rate for "high consumers" described in the EPA 2000 Human Health Methodology)
       __ 	175 g/day (fish consumption rate used by EPA and some states/tribes for high frequency consumers or subsistence fishers in the Pacific Northwest in the Water Quality Standards Program)
       __ 	Other consumption rates (please specify value in g/day) 	
       __ 	Not applicable
           What default value does your state or tribe use in the risk assessments as a daily fish consumption rate for children?
       __   2.0 g/day
       __   4.0 g/day
       __   6.5 g/day
       __ 	Other consumption rates (please specify value in g/day) 	
       __ 	Not applicable
        What default value does your state or tribe use for exposure duration in its cancer risk assessments?
       __   30 years
       __   70 years
       __	75 years 
       __ 	Other exposure duration (please specify value in years) 	
       __ 	Not applicable
        What default value does your state or tribe use to estimate life expectancy in its risk assessments?
       __   70 years
       __   75 years
       __   80 years
       __ 	Other life expectancy (please specify value in years) 	
       __ 	Not applicable
           Does your state or tribe recommend a meal frequency format or number of meals over time in its advisories (e.g., number of meals per month or meals per week)?
          __	Yes	__  No	__   Not applicable

          
           What number of meals over time (e.g., per month) does your state or tribe use in its advisories?  
	__ 	1 meals per week
	__ 	4 meals per month
	__ 	Other (please specify)_________________
           If the response to question 54 is yes, what assumption does your state or tribe make in its risk assessments about meal size or portion for adults? (Please specify all that apply)
       __  4 oz (114 g)
       __  8 oz (227 g)
       __  12 oz (341 g)
       __  16 oz (454 g)
       __ 	Other (please specify value in grams) 	
       __ 	Not applicable
           If the response to question 54 is yes, what assumption does your state or tribe make in its risk assessments about meal size or portion for children? (Please specify all that apply)
       __  4 oz (114 g)
       __  8 oz (227 g)
       __  12 oz (341 g)
       __  16 oz (454 g)
       __ 	Other (please specify value in grams) 	
       __ 	Not applicable
       
           What default value does your state or tribe use for body weight of an average adult consumer in its risk assessments?
       __   80 kg
       __   71 kg
       __   70 kg
       __   71 kg
       __	65 kg
       __   Other weight (please specify value in kg) 	
       __   Not applicable
           What default value does your state or tribe use for body weight of a pregnant person and nursing mothers in its risk assessments?
       __	80 kg
       __   75 kg
       __  70 kg
       __   65 kg
       __   62 kg
       __ 	Other weight (please specify value in kg) 	
       __ 	Not applicable
        What default value does your state or tribe use for body weight of a child in its risk assessments?
       __   10 kg
       __   14.5 kg
       __   15.5 kg
       __ Other weight (please specify value in kg) 	
       __ Risk assessments not conducted for children
       __ Not applicable


           Please specify what age range or ranges your state or tribe uses to calculate risk with respect to children. (Please specify all age ranges used in your state's risk assessments for children.)
       __   <1 year
       __   <6 years
       __	<7 years
       __   <12 years
       __   <15 years
       __	<18 years
       __ Other age ranges (please specify) 	
       __ Risk assessments not conducted for children
       __ Not applicable
           Does your state or tribal agency have a plan to reevaluate data from sites where outdated assessment methods were used to issue fish advisories?
          __ Yes	__  No	__ Not applicable

           Is your state or tribe currently re-evaluating the overall method or approach used to establish fish advisories?
       	__ Yes	__  No	__ Not applicable
           What assumption does your state make in its risk assessments about the amount of the pollutant absorbed by the body after ingestion (percent absorption by the gut) (e.g., in pharmacokinetic modeling)?
       __ 100% for all pollutants 
       __ 75% for all pollutants 
       __ 50% for all pollutants
       __ Chemical-specific % based on available data
       __ Other (please specify) 	
       __ Not applicable
           Does your state or tribe use "contaminant reduction factors" in its risk calculations to account for contaminant losses of PCBs and other organochlorine pollutants from fish tissues during cleaning, preparation, and cooking of the fish?
          __ Yes	__  No	__ Not applicable

           If yes, what are the pollutants and their associated contaminant reduction factors (% reduction in pollutant level resulting from cleaning, preparing, and cooking of fish) assumed by your state or tribe?

       __	% chlordane
       __	% DDE
       __	% DDT
       __	% dieldrin
       __	% heptachlor epoxide
       __ 	Not applicable
       __	% mercury
       __	% mirex
       __	% total PCBs
       __	% toxaphene
       __	% other (please specify)___________________

        If contaminant reduction factors are used, what are their basis?
       __ EPA Fish Advisory Guidance Documents
       __ Great Lakes Consortium Protocols and Best Practices for Uniform Fish Advisories
       __ Scientific literature review
       __ Conducted own research
       __ Other (please specify)  	
       __ Not applicable
       
 Is relative source contribution (RSC) used to account for other sources or pathways of exposure (e.g., drinking water, other foods) used in fish advisories?
       __ Yes	__  No
       
 If the response to question 68 is yes, specify the RSC used for the following contaminants:
        ______Hg 			______PCBs 			______PFAS
           How does your state or tribe evaluate health risks for fish samples contaminated with multiple chemicals with the same human health endpoints (e.g., two organochlorine pesticides)?
       __ Cumulative risk (add individual contaminant risks from each chemical together)
       __ Calculate single contaminant risk based on the most conservative carcinogenic risk or noncancer benchmark value
       __ Either cumulative risk or single contaminant risk depending on the chemicals involved
       __ Other method (please specify) 	
       __ State or tribe does not evaluate health risks for multiple contaminants
       __ Not applicable
           Regarding mercury, does your state or tribe use the EPA RfD (0.1 ug/kg/day) for different populations (i.e., for women of child-bearing age, children and adults in the general population)?
       __ Yes	__  No (specify, women of child-bearing age)_____________________
          		(specify, children)_____________________
          		(specify, adults in the general population)_____________________
          
 Regarding PFOS, does your state or tribe use the EPA RfD (0.02 ug/kg/day)?
	__ Yes	__  No (specify)_____________________

 Does your state or tribe use the cancer or non-cancer value for PCBs in fish advisories?
       __ Cancer		__ Non-cancer		__ Other(please specify)_____________ 	__ Not applicable
           
           When your state or tribe receives method detection limits (MDLs) as the reportable concentration for contaminants from the laboratory, what value are used for non-detects in your risk assessment?
       __ Zero
       __ Pollutant's MDL
       __ Half the pollutant's MDL
       __ Other value (please specify) 	
       __ Maximum likelihood indicator
       __ Not applicable
        Does your state or tribe screen for some or all of the PFAS compounds in question 33 (excluding PFOS and PFOA) in its fish tissue samples?
	__ Yes		__ No





           What risk assessment method does your state or tribe use for these PFAS compounds since there are no associated reference doses developed by EPA? (Please specify assessment method used)

       __ Not applicable
       
       Targeting Fish Consumers
           Are health risks being assessed by your state or tribe for target groups of people who may consume higher amounts of fish or prepare fish differently than the general population ?
        __ Yes	__ No	__ Not applicable

        Has your state or tribe identified the primary waterbodies fished by these target population(s)?
        __ Yes	__ No	__ Not applicable

           Has your state or tribe made efforts to identify the fish species and the sizes of fish consumed by these target populations?
        __ Yes	__ No	__ Not applicable

           If yes, has your state or tribe used any of the following procedures to obtain information from these target populations? (Please check all that apply)
       __ Local fish consumption surveys (creel surveys)
       __ Fishing license surveys
       __ Anecdotal information from populations of interest
       __ Behavioral risk surveillance surveys funded by the Centers for Disease Control and Prevention
       __ Other (please specify)_______________________________
       __ Not applicable
        Has your state or tribe altered its monitoring approach to address the needs of these target populations?
       __ Yes	__ No	__ Not applicable

           If your state or tribe has altered its monitoring approach to address the needs of these target populations, what actions have been taken? (Please check all that apply)
       __ Added stations in waterbodies where the targeted populations frequently fish
       __ Collected species consumed by the target populations for contaminant analyses
       __ Other actions (please specify) 	
       __ Not applicable
           If your state or tribe is not currently addressing the concerns of populations with a perceived higher risk, is there a plan to do so in the future?
       __ Yes	__ No	__ Not applicable
          
       Risk Management
           Who prepares risk assessments on behalf of your state or tribal fish advisory program? (Please check all that apply)
       __ State or Tribal Environmental Agency/Department 
       __ State or Tribal Public Health Agency/Department 
       __ State or Tribal Fisheries Agency/Department
       __ Consultant
       __ University
       __ Other (please specify) 	
       __ Not applicable
       
           Does your state or tribe have written procedures for evaluating the health risks associated with consumption of contaminated fish?
          __ Yes	__ No	__ Not applicable

           Does your state or tribe have a group or committee that oversees the fish advisory program/processes?
          __ Yes	__ No	__   Not applicable

           If the answer to question 86 is yes, what professional disciplines are represented on that committee? (Please check all that apply)
       __ Toxicology/epidemiology
       __ Fisheries biologist
       __ Water pollution assessment/control
       __ Hazardous waste management
       __ Analytical chemist
       __ Risk communication
       __ Other disciplines (please specify)  	
       __ Not applicable

           Who in your state or tribe makes the ultimate risk management decision to issue, modify, or rescind fish advisories?
       __ Head of Environmental Agency/Department 
       __ Head of Public Health Agency/Department 
       __ Head of Fisheries Agency/Department
       __ Governor's Office or Tribal Chief's/President's Office
       __ Other (please specify)  	
       __ Not applicable

       Risk Communication Procedures
           Is your state or tribe aware of recently released update to EPA's Risk Communication Guidance (Volume 4) ?
 	__ Yes	__ No
 	
           If your response to question 89 is yes, is the guidance useful?
          __ Yes	__ No
 		Provide Comments:_______________________________________________________________		________________________________________________________________
           How often does your Agency revise the fish consumption advisory listings and release the information to the public? (Please check all that apply)
       __ Annually; released on	(specify date: Day/Month)
       __ Whenever data become available (on an as-needed basis)
       __ Other schedules (please specify) 	
       __ Not applicable

       

           How are your Agency's fish advisories communicated to the public? (Please check all that apply)
       __	Social Media (specify)________________________
       __ Mailed to public upon request
       __ Press releases distributed to media sources
       __ Targeted newspaper stories
       __ Published articles in ethnic newspapers
       __ Videos for ethnic groups
       __ Radio announcements
       __ Television announcements __ Radio/television talk shows
       __Podcasts
       __ Internet site
       __ Agency telephone information service (i.e., hotlines)
       __ Agency magazine
       __ Posted signs (at boat launches, stream access points, public docks, etc.)
       __ Posted information where fishing licenses issued __ Posters in public places (libraries, town halls, etc) __ Annual fishing regulations booklet
       __ Generic statewide listing booklet separate from fishing regulations
       __ Printed pamphlets or fact sheets
       __ Information presented at public meetings
       __ Publication of articles in state medical journal
       __ Publication of articles in agency annual monitoring report
       __ Publication of information in state 305(b) report 
       __ Flyers distributed with trout and salmon stamps 
       __ GIS maps posted 
       __ Other methods (please specify) 	
       __ Not applicable
       
           Where can the public obtain copies of your agency's printed advisory materials? (Please check all that apply)
       __ Local public health departments 
       __ State or tribal public health departments
       __ State or tribal Internet site
       __ Other State agencies
       __ Doctors' offices
       __ Local businesses (e.g., hair styling salons)
       __ Businesses that issue fishing licenses (e.g., bait and tackle shops)
       __ WIC (Women, Infants, and Children) clinics
       __ Welfare offices
       __ Organizations (e.g., sporting or women's clubs)
       __ Tourist offices
       __ State or tribal  fisheries offices 
       __  Town halls
       __ Law enforcement officers
       __ Other sources (please specify) 	
       __ Not applicable
           Does your state or tribal fish advisory outreach or communication plan specifically target some populations to receive advisory information?
          __ Yes	__	No	__ Not applicable

          

        If yes, please identify all targeted populations.	(Please check all that apply)
       __ Sport fishers
       __ Subsistence fishers
       __ Specific racial/ethnic groups (please specify) 	
       __ Women of child-bearing age
       __ Pregnant or nursing women
       __ New parents
       __ Tourists
       __ Members of the general population
       __ Others (please specify)  	
       __ Not applicable

           Are your state or tribal fish consumption advisories available to the public in languages other than English?
          __ Yes	__ No	__ Not applicable
          
 If yes, please specify all languages that apply.
__
Alaskan native languages
                                                                             __
 Llacano
__
Bosnian
                                                                             __
 Ojibwa
__
Cambodian
                                                                             __
 Portugese
__
Chinese
                                                                             __
 Russian
__
Creole
                                                                             __
 Spanish
__
Hmong
                                                                             __
 Tagalog
__
Japanese
                                                                             __
 Thai
__
Korean
                                                                             __
 Vietnamese
__
Laotian
                                                                             __
 Others (please specify)  	


                                                                             __
 Not applicable

       98. Does your state or tribe evaluate the effectiveness of the fish consumption advisories?
          __	Yes	__	No	__ Not applicable

 99. If yes, how is their effectiveness determined? (Please check all that apply)
       __ Feedback form/postcard in regulation pamphlet
       __ Questions included in creel census program
       __ Questions included in state BRFS (Behavior Risk Factor Survey)
       __ Focus groups
       __ Mailed questionnaires (to whom?)  	 
       __ Telephone surveys (of whom?)  	 
       __ Other methods (please specify)  	 
       __ Not applicable
       
       100. To your knowledge, have there been any studies in your state (including federal, tribal, and university-based studies) to evaluate the effectiveness of fish consumption advisories?
       __ Don't know
       __ No
       __ Yes (please specify)  	


       101. To your knowledge, have there been any studies in your state (including federal, tribal, and university-based studies) to evaluate human tissue contaminant levels (e.g., in blood, urine, breast milk, or adipose tissues) or adverse human health effects related to fish consumption?
       __ Don't know
       __ No
       __ Yes (please specify organization or agency)  	

