1
PART
A
OF
THE
SUPPORTING
STATEMENT
1.
IDENTIFICATION
OF
THE
INFORMATION
COLLECTION
1(
a)
Title
of
the
Information
Collection
Adult
Construction
Worker
Soil
Ingestion
Research
1(
b)
Short
Characterization
of
the
Information
Collection
This
research
will
examine
the
amount
of
soil
ingested
by
adult
construction
workers.
Soil
is
ingested
in
two
ways,
incidental
ingestion
from
everyday
hand
to
mouth
activity
and
ingestion
resulting
from
inhaled
particles
of
soil
that
are
deposited
in
upper­
and
middle­
respiratory
tract
and
swallowed.
The
ingestion
of
soil
is
important
because
contaminated
soils
from
a
hazardous
waste
site
pose
risks
to
individuals
exposed
to
contaminated
soil.

The
University
of
Massachusetts
at
Amherst
has
conducted
several
studies
on
soil
ingestion
in
children
and
adults.
Existing
studies
by
this
research
group
provide
an
important
contribution
to
our
overall
understanding
of
soil
ingestion.
This
research
group
has
studied
ingestion
by
comparing
the
amount
of
trace
metals
that
are
ingested
in
food
with
the
amount
of
metals
that
are
excreted.
Any
amount
in
excess
of
the
ingested
trace
metals
is
attributed
to
incidental
soil
ingestion.

In
particular,
the
University
of
Massachusetts
has
conducted
pilot
studies
in
adults
that
reported
a
good
relationship
for
trace
metals
that
were
ingested.
These
studies
reported
an
ability
to
distinguish
and
report
trace
metal
levels
that
are
in
the
range
of
levels
that
expected
to
be
ingested
by
adult
construction
workers.
However,
this
work
supports
the
logical
follow
up
work
to
evaluate
the
ingestion
rate
of
soil
in
adults,
specifically
adult
construction
workers.
Adult
construction
workers
face
many
hours
of
dusty
condition,
which
is
created
by
their
work
activities.
For
this
reason
construction
workers
are
expected
to
be
a
population
at
high
risk
of
incidental
ingestion.

The
proposal
responds
to
limitations
in
previous
studies
and
promises
to
advance
our
understanding
of
soil
ingestion
in
adult
construction
workers.
This
study
is
being
funded
by
EPA
and
the
Chemical
Manufacturers
Association.
The
funding
includes
approximately
about
$
430,000
from
EPA
and
over
$
130,000
from
the
Chemical
Manufacturers
Association.
The
study
design
has
been
subject
to
EPA's
quality
assurance
process
and
review
processes.

This
study
is
designed
to
address
soil
ingestion
in
adult
construction
workers.
There
are
only
a
few
studies
in
this
area
and
they
have
been
conducted
with
only
a
few
subjects
or
have
major
limitations.
The
limitations
to
existing
studies
really
provide
a
poor
basis
for
estimating
adult
soil
ingestion,
which
is
an
important
factor
in
assessing
adult
risks
when
soil
contact
is
expected.
2
The
information
to
be
collected
in
this
research
project
is
limited
information
from
the
20
subjects
that
have
signed
up
for
the
study.
The
subjects
are
paid
for
their
participation
and
reimbursed
for
the
costs
of
duplicate
meals
during
the
study
period
(
which
are
used
to
estimate
the
amount
of
trace
metals
ingested
by
study
participants).
Each
study
participant
is
to
complete
questionnaires
each
day
that
helps
to
establish
any
behavior
that
may
affect
study
results.

2.
NEED
FOR
AND
USE
OF
THE
COLLECTION
2(
a)
Need/
Authority
for
the
Collection
Past
studies
with
children
and
adults
show
that
daily
variations
associated
with
a
variety
of
factors
can
contribute
to
differences
in
trace
metal
excretion.
The
factors
contributing
to
variation
in
trace
metal
include:
certain
foods,
toothpaste
and
variations
in
individual
biology.

This
research
is
being
done
under
the
authority
of
CERCLA
311(
c)
to
improve
our
basis
for
conducting
risk
assessments
at
Superfund
sites.

2(
b)
Practical
Utility/
Users
of
Data
The
results
of
this
study
could
improve
our
estimates
of
adult
incidental
soil
ingestion.
This
is
an
important
consideration
in
the
development
of
adult
risk
assessments
for
outside
workers.
Available
data
in
this
area
is
very
limited.
Potential
users
of
this
information
include
EPA
hazardous
waste
programs
(
and
possibly
other
EPA
programs),
state
agencies
that
perform
risk
assessment
work,
academic
institutions,
and
others.

3.
NONDUPLICATION,
CONSULTATIONS
AND
OTHER
COLLECTION
CRITERIA
3(
a)
Nonduplication
There
is
no
other
known
planned
effort
to
address
this
issue.
This
effort
will
be
jointly
funded
by
both
the
federal
government
and
industry.

3(
b)
Public
Notice
Required
Prior
to
ICR
Submission
to
OMB
In
compliance
with
the
1995
Paperwork
Reduction
Act,
as
this
ICR
is
non­
rule­
related,
EPA
solicited
public
comments
for
a
60­
day
period
prior
to
submitting
this
ICR
to
OMB.
EPA
received
no
comments.
A
copy
of
the
notice
that
appeared
in
the
Federal
Register
is
included
in
Appendix
1(
65
FR
69936;
November
21,
2000).
3
3c
Consultations
As
a
research
proposal
being
funded
under
the
authority
of
311(
c)
of
CERCLA,
this
research
was
peer
reviewed.
In
addition
to
peer
review,
consultations
with
a
variety
of
EPA
authorities
on
soil
ingestion
were
consulted.
These
individuals
include:

Dr.
Lester
Grant,
Director
National
Center
for
Environmental
Assessment
(
EPA)
Research
Triangle
Park,
NC
27711
919­
541­
4173
Paul
White
National
Center
for
Environmental
Assessment
(
EPA)
Washington,
DC
20460
202­
564­
3278
In
addition,
discussions
have
been
held
with
a
variety
of
others
including
ATSDR
contacts,
the
Technical
Review
Workgroup
for
Lead
(
a
cross
Agency
group
of
scientists
that
support
the
development
of
lead
risk
assessment
approaches
for
hazardous
waste
sites),
and
others
involved
in
exposure
and
risk
analysis
within
the
Agency.

3(
d)
Effects
of
Less
Frequent
Collection
The
questionnaire
is
a
one­
time
data
collection
to
support
this
specific
study.
Data
collection
efforts
will
not
be
repeated,
although
information
may
need
to
be
updated
periodically
during
the
study
process.
Updates
will
be
requested
only
on
an
as­
needed
basis
for
specific
data
elements,
not
for
the
entire
questionnaire.

3(
e)
General
Guidelines
As
this
is
a
one­
time
data
collection
effort,
no
special
records
must
be
maintained
by
the
respondents
to
complete
the
questionnaire
or
updates.
It
is
however,
recommended
that
the
respondents
keep
one
copy
on
file
to
respond
to
any
follow­
up
questions.
This
information
collection
complies
with
the
guidelines
in
the
Paperwork
Reduction
Act
(
5
CFR
1320.5(
d)(
2)).
Specifically,
the
collection
does
not
require
the
respondents
to:

°
Report
information
to
EPA
more
often
than
quarterly;
°
Prepare
a
written
response
to
a
collection
in
fewer
than
30
days
after
receipt
of
it;
°
Submit
more
than
one
original
document;
°
Retain
any
records
for
more
than
three
years;
°
Participate
in
a
statistical
survey
that
is
not
designed
to
produce
data
that
can
be
generalized
to
the
universe
of
study;
4
°
Use
a
statistical
data
classification
that
has
not
been
reviewed
and
approved
by
OMB;
and
°
Submit
any
information
that
they
may
consider
to
be
confidential,
without
EPA
demonstrating
that
it
has
instituted
procedures
to
protect
the
information's
confidentiality
to
the
extent
permitted
by
law.

3(
f)
Confidentiality
Information
in
this
questionnaire
is
personal
and
will
be
protected
to
the
extent
possible.
OGC
has
indicated
that
the
information
may
be
subject
to
requests
from
the
outside.

3(
g)
Sensitive
Questions
The
questionnaire
does
not
ask
any
sensitive
questions
pertaining
to
sexual
attitudes/
behavior
or
religious
beliefs.

4.
THE
RESPONDENTS
AND
THE
INFORMATION
COLLECTED
4(
a)
Respondents
The
20
paid
respondents
are
participants.
Because
the
study
is
expected
to
be
broken
out
into
two
weeks,
which
could
be
separated
in
time,
it
is
possible
that
there
would
be
some
changes
in
the
subjects,
but
the
study
design
is
intended
to
collect
information
from
20
subjects
during
two
one­
week
periods.

4(
b)
Information
Required
The
types
of
questions
asked
are
needed
to
determine
if
the
study
protocol
has
been
followed.
For
example,
if
duplicate
samples
of
all
foods
consumed
are
not
provided,
then
the
estimate
of
trace
metals
from
food
will
be
biased
low.
Other
information
such
as
hand
washing
before
meals
will
be
useful
to
understand
individual
habits
that
are
likely
to
affect
study
results.

4(
c)
Respondent
Activities
To
collect
the
necessary
information,
the
Agency
will
require
respondents
to
fill
out
the
questionnaire
daily.
The
questionnaire
will
be
used
to
evaluate
the
extent
to
which
study
protocols
have
been
followed.
This
information
will
be
used
in
the
analysis
of
data.
Information
from
the
questionnaires
could
provide
a
basis
for
excluding
data
for
an
individual
in
study
analysis.

5.
THE
INFORMATION
COLLECTED
­­
AGENCY
ACTIVITIES,
COLLECTION
METHODOLOGY
AND
INFORMATION
MANAGEMENT
5
5(
a)
Agency
Activities
The
information
collected
addresses
information
needed
to
insure
that
the
study
protocol
has
been
followed.
The
use
of
an
unknown
toothpaste
or
consumption
of
food
that
does
not
have
a
duplicate
sample
that
will
be
analyzed
for
trace
metal
content
introduces
uncertainty
into
the
study.
The
information
questionnaire
has
been
designed
by
University
of
Massachusetts
staff
and
they
would
collect,
store,
maintain,
and
analyze
the
information
along
with
other
information
collected
during
the
study.

5(
b)
Collection
Methodology
and
Management
The
questionnaire
was
written
in
"
plain
language"
format
to
ensure
that
questions
were
asked
in
a
clear
and
concise
manner
and
to
reduce
burden.
The
questionnaire
is
designed
specifically
to
obtain
the
necessary
information
with
the
least
amount
of
burden
and
confusion
to
the
respondent.

To
reduce
the
burden
on
the
construction
industry,
it
was
determined
that
collection
this
information
from
all
construction
facilities
would
not
be
necessary.
Collection
of
this
information
from
a
small
number
of
construction
workers
using
the
improved
methods
proposed
will
significantly
improve
the
basis
for
estimation
of
soil
ingestion
for
construction
workers.

The
results
of
the
analysis
of
trace
metals
from
human
waste
will
be
used
to
compare
with
the
survey
results.
The
questionnaire
will
be
administered
daily
by
phone
or
in
person.
Each
study
participant
will
interact
with
someone
from
the
study
team
every
day
to
ensure
that
surveys
are
collected.
These
daily
questionnaires
will
aid
in
determining
if
study
protocols
have
been
followed
for
this
study.
Unexpected
elevated
levels
of
trace
metals
may
be
associated
with
a
failure
to
follow
the
study
protocol.
The
survey
will
be
helpful
in
resolving
this
type
of
discrepancy.
At
this
time,
we
expect
that
the
University
of
Massachusetts
will
maintain
surveys
and
results
of
survey
analyses.
These
surveys
will
support
analysis
and
ultimate
publication
of
results.

Given
that
data
will
be
collected
as
part
of
this
study,
this
effort
involved
the
development
of
a
quality
assurance
project
plan,
which
was
reviewed
in
conjunction
with
the
study
proposal.

Together
these
two
documents
show
that
the
data
collection
practices
are
consistent
with
the
study
design.
Because
this
is
a
research
project,
it
has
been
subject
to
peer
review
and
additional
reviews
are
planned
to
help
guide
the
study.
Finally,
there
is
no
other
known
or
planned
study
that
has
evaluated
soil
ingestion
in
adult
construction
workers.
Therefore,
there
is
no
known
or
anticipated
duplication
of
effort
for
this
study.
6
5(
c)
Small
Entity
Flexibility
For
this
collection
effort,
participation
is
voluntary
for
individuals
that
have
volunteered
to
participate
in
a
research
study.

5(
d)
Collection
Schedule
Following
notification
in
the
Federal
Register
and
subsequent
approval
by
OMB,
EPA
estimates
that
the
construction
worker
questionnaire
will
be
distributed
to
the
study
participants
this
summer
when
the
study
begins.
The
study
is
expected
to
be
broken
out
into
two
weeks,
which
could
be
separated
in
time.
Data
will
be
entered
into
a
spreadsheet/
database.
Following
QA
of
the
data
system,
analysis
of
the
questionnaire
data
will
begin
by
November
2001.

6.
ESTIMATING
THE
BURDEN
AND
COST
OF
THE
COLLECTION
6(
a)
Estimating
Respondent
Burden
The
burden
to
participants
will
be
the
time
required
to
fill
out
each
questionnaire
each
day.
About
5
minutes
is
expected
to
be
required
to
fill
out
the
daily
questionnaire.
If
this
questionnaire
is
required
a
day
Sunday
through
Saturday
for
the
study,
then,
we
expect
that
the
weekly
time
required
per
participant
will
be
about
a
half
hour.
Questionnaires
will
be
collected
during
regular
contact
between
the
study
staff
and
the
study
participants.

6(
b)
Estimating
Respondent
Costs
None.

6(
c)
Estimating
Agency
Burden
and
Cost
None,
part
of
the
research
study.
Costs
are
a
necessary
part
of
the
research.

6(
d)
Estimating
the
Respondent
Universe
and
Total
Burden
and
Costs
The
respondent
universe
is
about
20
subjects
that
will
be
part
of
this
study.
Respondents
will
be
paid
for
their
time
and
study
participation.
Burden
of
this
questionnaire
will
be
incidental
to
the
conduct
of
the
study.

6(
e)
Bottom
Line
Burden
Hours
and
Costs
Expect
about
20
hours
for
reporting
associated
with
this
questionnaire.

6(
f)
Reasons
for
Change
in
Burden
7
This
section
does
not
apply
to
this
ICR
since
EPA
is
not
renewing
or
modifying
an
existing
ICR
at
this
time.

6(
g)
Burden
Statement
EPA
has
developed
the
following
burden
statement
for
the
questionnaire.
It
is
a
brief
statement
of
the
estimated
burden
for
the
Adult
Construction
Worker
Soil
Ingestion
Research
along
with
a
request
for
comments
and
suggestions
regarding
the
respondent
burden
of
the
questionnaire.

Public
reporting
burden
for
this
collection
of
information
is
estimated
to
average
5
minutes
per
response,
including
the
time
for
reviewing
instructions,
gathering
information,
and
completing
and
reviewing
the
collection
of
information.
Send
comments
on
the
Agency's
need
for
this
information,
the
accuracy
of
the
provided
burden
estimates,
and
any
suggestions
for
reducing
the
burden,
including
the
use
of
automated
collection
techniques
to
the
Director,
Office
of
Environmental
Information,
United
States
Environmental
Protection
Agency
(
Mail
Code
2822),
1200
Pennsylvania
Ave.,
NW,
Washington,
D.
C.
20004.
Do
not
send
your
completed
questionnaires
to
this
address
since
it
is
only
for
comments.
Include
the
EPA
ICR
number
1965.01
and
the
OMB
control
number
in
any
correspondence.

PART
B
OF
THE
SUPPORTING
STATEMENT.

This
is
not
a
statistical
survey
but
a
questionnaire
designed
to
ensure
that
the
protocol
for
a
research
study
is
being
followed.
This
is
a
study
of
20
individuals.
8
Appendix
A.
Federal
Register
Notice
Soliciting
Comments
on
the
Burden
Estimates
for
Respondents
9
ENVIRONMENTAL
PROTECTION
AGENCY
[
FRL­
]

Agency
Information
Collection
Activities:
Proposed
Collection;
Comment
Request;

Soil
Ingestion
Research
Study
AGENCY:
Environmental
Protection
Agency
(
EPA).

ACTION:
Notice.

SUMMARY:
In
compliance
with
the
Paperwork
Reduction
Act
(
44
U.
S.
C.
3501
et
seq.),
this
document
announces
that
EPA
is
planning
to
submit
the
following
proposed
Information
Collection
Request
(
ICR)
to
the
Office
of
Management
and
Budget
(
OMB):

Soil
Ingestion
Research
Study
(
EPA
ICR
Number
1965.01).
Before
submitting
the
ICR
to
OMB
for
review
and
approval,
EPA
is
soliciting
comments
on
specific
aspects
of
the
proposed
information
collection
as
described
below.

DATES:
Comments
must
be
submitted
on
or
before
[
Insert
date
60
days
after
publication
in
the
FEDERAL
REGISTER].

ADDRESSES:
Comments
submitted
by
regular
U.
S.
Postal
Service
mail
should
be
sent
to:

Docket
Coordinator,
Superfund
Docket
Office,
Mail
Code
5201G,
U.
S.
Environmental
Protection
Agency
Headquarters,
Ariel
Rios
Building,
1200
Pennsylvania
Avenue,
NW.,
Washington,

DC
20460.
To
ensure
proper
receipt
by
EPA,
it
is
imperative
that
you
identify
docket
control
number
SOIL­
INGEST
in
the
subject
line
on
the
first
page
of
your
comment.
Comments
may
also
be
submitted
electronically
or
in
person.
Please
follow
the
detailed
instructions
for
these
submission
methods
as
provided
in
unit
III
of
the
SUPPLEMENTARY
INFORMATION
section.

Copies
of
the
ICR
may
be
obtained
from
this
office
(
contact
Larry
Zaragoza
703­
603­
8867),
or
10
the
Office
of
Environmental
Information's
ICR
website
at
http://
www.
epa.
gov/
icr/.

FOR
FURTHER
INFORMATION
CONTACT:
Larry
Zaragoza,
Office
of
Emergency
and
Remedial
Response,
at
703­
603­
8867/
703­
603­
9133
(
fax),
email:
Zaragoza.
Larry@
EPA.
Gov.

SUPPLEMENTARY
INFORMATION:

Affected
Entities:
Entities
potentially
affected
by
this
action
are
those
which
agree
to
participate
in
a
research
study
on
soil
ingestion.

Title:
Soil
Ingestion
Research,
(
EPA
ICR
No.
1965.01
).

Abstract:
This
ICR
supports
research
to
examine
the
amount
of
soil
ingested.
Soil
is
ingested
in
two
ways,
incidental
ingestion
from
everyday
hand
to
mouth
activity
and
ingestion
resulting
from
inhaled
particles
of
soil
that
are
deposited
in
upper
and
middle
respiratory
tract
and
swallowed.
The
ingestion
of
soil
is
important
because
contaminated
soils
from
a
hazardous
waste
site
poses
risks
to
individuals
exposed
to
contaminated
soil.
This
research
should
help
any
environmental
program
concerned
with
contaminated
soils
but
is
specifically
being
sponsored
by
Superfund.
This
research
will
evaluate
ingestion
by
comparing
the
amount
of
trace
metals
that
are
ingested
in
food
with
the
amount
of
metals
that
are
excreted,
any
amount
in
excess
of
the
ingested
trace
metals
is
attributed
to
incidental
soil
ingestion.
Because
of
the
possibility
of
trace
metal
ingestion
from
a
variety
of
sources
(
like
food
and
toothpaste),
a
questionnaire
to
identify
and
characterize
sources
of
trace
metals
that
can
affect
daily
variation
in
trace
metals
is
an
important
part
of
the
experimental
design
of
these
studies.
About
20
study
volunteers
are
paid
and
are
expected
to
participate
in
this
study
for
about
two
weeks.
Each
night
the
study
participants
would
participate
in
a
questionnaire
that
will
later
be
used
to
help
interpret
daily
variations
in
trace
metals.
An
agency
may
not
conduct
or
sponsor,
and
a
person
is
not
required
to
respond
to,
11
a
collection
of
information
unless
it
displays
a
currently
valid
OMB
control
number.
The
OMB
control
numbers
for
EPA's
regulations
are
listed
in
40
CFR
part
9
and
48
CFR
Chapter
15.

The
EPA
would
like
to
solicit
comments
to:

(
i)
evaluate
whether
the
proposed
collection
of
information
is
necessary
for
the
proper
performance
of
the
functions
of
the
agency,
including
whether
the
information
will
have
practical
utility;

(
ii)
evaluate
the
accuracy
of
the
agency's
estimate
of
the
burden
of
the
proposed
collection
of
information,
including
the
validity
of
the
methodology
and
assumptions
used;

(
iii)
enhance
the
quality,
utility,
and
clarity
of
the
information
to
be
collected;
and
(
iv)
minimize
the
burden
of
the
collection
of
information
on
those
who
are
to
respond,

including
through
the
use
of
appropriate
automated
electronic,
mechanical,
or
other
technological
collection
techniques
or
other
forms
of
information
technology,
e.
g.,

permitting
electronic
submission
of
responses.

Burden
Statement:
During
the
study,
paid
research
subjects
would
fill
out
a
questionnaire
on
a
daily
basis.
Questions
could
take
5
minutes.
This
reporting
burden
would
involve
approximately
20
research
subjects
who
are
expected
to
participate
in
a
study
for
2
weeks.
This
information
would
be
collected
by
the
researchers
at
the
research
institution
conducting
the
study
and
the
data
would
be
maintained
by
this
group,
not
the
Federal
government.
Burden
means
the
total
time,
effort,
or
financial
resources
expended
by
persons
to
generate,
maintain,
retain,
or
disclose
or
provide
information
to
or
for
a
Federal
agency.
This
includes
the
time
needed
to
review
instructions;
develop,
acquire,
install,
and
utilize
technology
and
systems
for
the
purposes
12
of
collecting,
validating,
and
verifying
information,
processing
and
maintaining
information,
and
disclosing
and
providing
information;
adjust
the
existing
ways
to
comply
with
any
previously
applicable
instructions
and
requirements;
train
personnel
to
be
able
to
respond
to
a
collection
of
information;
search
data
sources;
complete
and
review
the
collection
of
information;
and
transmit
or
otherwise
disclose
the
information.

Dated:
________________
Elaine
F.
Davies,
Acting
Director
Office
of
Emergency
and
Remedial
Response
13
Appendix
B.
Draft
Adult
Construction
Worker
Soil
Ingestion
Research
Questionaire
OMB
Control
No.:
2050­
XXXX
Expiration
Date:
xx/
xx/
xxxx
14
ADULT
VALIDATION
NIGHTLY
QUESTIONNAIRE
Each
evening
the
study
team
will
ask
the
participant
via
telephone
the
following
questions.

Phone:
_______________

Name
of
Participant:_________________________
ID:
_____________

Name
of
Interviewer:________________________
IID:
_____________

Interview
Conduct
Time:
_______________
AM
Or
_______________
PM
Date:
______________________

1.
Were
any
food/
drink
samples
that
you
ingested
today
not
placed
in
the
container?

IF
YES:
Yes

1
No

0
Was
anything
missing
at...

a.
Breakfast?
Yes

1
No

0
IF
YES:
What
was
Missed?
_________________

b.
Lunch?
Yes

1
No

0
IF
YES:
What
was
Missed?
_________________

c.
Dinner?
Yes

1
No

0
IF
YES:
What
was
Missed?
_________________

d.
Any
Snacks?
Yes

1
No

0
IF
YES:
What
was
Missed?
_________________

IF
YES
TO
ANY
Why
were
they
missed?
_______________________________________________
OMB
Control
No.:
2050­
XXXX
Expiration
Date:
xx/
xx/
xxxx
15
2.
Did
you
put
anything
in
the
containers
that
you
did
not
each
(
i.
e.,
apple
core,
bones,
corn
cobs,
etc.)

Yes

1
No

0
IF
YES:
What
items
didn't
you
eat?
_________________

2a.
Did
you
directly
touch
with
your
fingers
any
of
the
food
you
ingested
at:

a.
Breakfast?
Yes

1
No

0
b.
Lunch?
Yes

1
No

0
c.
Dinner?
Yes

1
No

0
d.
Any
Snacks?
Yes

1
No

0
2a.
Did
you
wash
you
hands
immediately
prior
to
eating?

a.
Breakfast?
Yes

1
No

0
b.
Lunch?
Yes

1
No

0
c.
Dinner?
Yes

1
No

0
d.
Any
Snacks?
Yes

1
No

0
3.
Did
you
miss
or
lose
any
fecal
samples
today
such
that
they
were
not
planed
in
the
container(
s)?
Yes

1
No

0
IF
YES:
What
proportion
(%)
of
the
total
sample
did
you
miss?
______%

4.
Did
you
miss/
lose
any
urine
samples
today
such
that
they
were
not
placed
in
the
container(
s)?
Yes

1
No

0
IF
YES:
What
proportion
(%)
of
the
total
sample
did
you
miss?
______%

5.
Are
the
food/
fecal/
urine
sample'
containers
properly
labeled
with
name,
date,
time,
and
food,
fecal
or
urine?
Yes

1
No

0
IF
NO:
Please
Explain
____________________________________________

6.
Did
you
ingest
any
of
the
food
today
that
we
was
to
be
totally
avoided?
Yes

1
No

0
IF
YES,
READ
THE
AVOIDANCE
FOOD
LIST
OMB
Control
No.:
2050­
XXXX
Expiration
Date:
xx/
xx/
xxxx
16
What
did
you
ingest,
and
how
much?
Food
Item
Quantity
_____________
___________

_____________
___________

_____________
___________

7.
How
many
waking
hours
did
you
stay
inside
you
home
today?
_____
HOURS
(
NEAREST
HALF)

8.
What
proportion
(%)
of
the
time
did
you
spend
in
the
following
rooms?

a.
Bedroom(
s)
____%
b.
Kitchen
____%
c.
Living
Room
____%
d.
Dining
Room
____%
e.
Basement/
Garage
____%
f.
Other
____%
TOTAL
100%

8.
Which
of
these
indoor
activities
did
you
do
today
at
home?

a.
Cooking
Yes

1
No

0
b.
Eating
Yes

1
No

0
c.
Reading
Newspaper
Yes

1
No

0
d.
Other
Reading
Yes

1
No

0
e.
Watching
TV
Yes

1
No

0
f.
Cleaning
Yes

1
No

0
g.
Playing
with
children
Yes

1
No

0
h.
Playing
with
pets
Yes

1
No

0
Other:
(
please
identify)
______________________________

10.
Did
you
take
a
bath
or
shower
today?
Yes

No

11.
How
many
hours
were
you
outside
and
not
at
work
today?
______
HOURS
(
NEAREST
HALF)
OMB
Control
No.:
2050­
XXXX
Expiration
Date:
xx/
xx/
xxxx
17
12.
What
type
of
outdoor
activities
did
you
do
at
home?

a.
Lawn
mowing
Yes

1
No

0
b.
Other
yard
work
Yes

1
No

0
c.
Gardening
Yes

1
No

0
d.
Walking/
Running
Yes

1
No

0
e.
Other
sports
Yes

1
No

0
Other
(
please
identify)
_____________________________________

13.
How
did
you
primarily
commute
to
and
from
work?

a.
Walk

1
b.
Car

2
c.
Motorcycle

3
d.
Bus

4
e.
Other

5
14.
How
long
did
you
spend
commuting?
___________
minutes?

15.
How
many
hours
were
you
at
the
work
site?

16.
How
many
hours
did
you
work
off
site?

17.
What
did
you
do
today
at
work?

18.
What
percent
of
time
did
you
spend
in
each
work
site
area?

a.
Area
A
____%
b.
Area
B
____%
c.
Area
C
____%
d.
Area
D
____%

19.
Did
you
wash
your
hands
prior
to
eating
Lunch?
Yes

1
No

0
20.
Did
you
wash
your
hands
prior
to
eating
snacks
at
the
work
site?
Yes

1
No

0
21.
Did
you
wash
you
hands
prior
to
eating
supper?
Yes

1
No

0
OMB
Control
No.:
2050­
XXXX
Expiration
Date:
xx/
xx/
xxxx
18
22.
Did
you
smoke/
chew
tobacco
at
the
work
site?
Yes

1
No

0
IF
YES
and
SMOKER:
About
how
many
cigarettes
did
you
smoke?
_____#
of
cigarettes
23.
Did
you
ingest
non­
food
items,
such
as
vitamin
pills,
medicines
Yes

1
No

0
24.
Did
you
chew
gum
today?

IF
YES:
How
many
sticks?
____
sticks
What
type?
__________

25.
Did
you
apply
underarm
deodorant?
Yes

1
No

0
IF
YES:
What
type
of
deodorant
did
you
use?
______________

26.
Did
you
apply
foot
powder?
Yes

1
No

0
IF
YES:
What
type
of
foot
powder
did
you
use?
______________

27.
Did
you
brush
your
teeth
today?
Yes

1
No

0
IF
YES:
Did
you
use
the
toothpaste
provided?
Yes

1
No

0
28.
Did
you
experience
any
unusual
exposure
to
chemical
agents
such
as
spills,
building
demolition,
or
other
circumstances
today?
Yes

1
No

0
IF
YES:
Please
describe
your
experience.

29.
Did
you
take
any
prescription
medicine
today?
Yes

1
No

0
30.
Did
you
have
any
unusual
exposure
to
dust?
Yes

1
No

0
31
Did
you
wear
any
protective
devices
such
as
dusk
masks,
respirators,
etc?
Yes

1
No

0
OMB
Control
No.:
2050­
XXXX
Expiration
Date:
xx/
xx/
xxxx
19
Thank
you
for
your
help
in
completing
this
questionnaire.
Your
responses
are
confidential.

Public
reporting
burden
for
this
collection
of
information
is
estimated
to
average
X
minutes
per
response,
including
the
time
for
reviewing
instructions,
gathering
information,
and
completing
and
reviewing
the
collection
of
information.
Send
comments
on
the
Agency's
need
for
this
information
the
accuracy
of
the
provided
burden
estimates,
and
any
suggestions
for
reducing
the
burden,
including
the
use
of
automated
collection
techniques
to
the
Director,
Office
of
Environmental
Information,
United
States
Environmental
Protection
Agency
(
Mail
Code
2822),
1200
Pennsylvania
Ave.,
NW,
Washington,
D.
C.
20004.
Do
not
send
your
completed
questionnaires
to
this
address
since
it
is
only
for
comments.
Include
the
EPA
ICR
number
1965.01
and
the
OMB
control
number
in
any
correspondence.
