Exposure Measurement Form – Post-activity questionnaire administration notice

OMB Attachment 3h2

Federal Government Study on the Use of Recycled Tire Crumbs in Synthetic Turf Fields

Your role as a synthetic turf (or natural grass field user) participant

Please arrive 15 minutes before your practice for pre-activity urine collection and stay 30 minutes after for your post-activity urine collection and questionnaire.

Please arrive at:

Please refrain from eating any grilled, barbequed, smoked, or deep fried foods for 24 hours before your scheduled appointment.

We will give you/your child a $25 gift card as a “thank you” when you or he/she completes the interview. The gift card can be used at most stores or for online shopping.

People who also provide urine samples will get additional gift cards ($10 pre-activity and $15 post-activity).

If you or your child have any questions about the study or wish to drop out, please contact:

Kelsey Benson

Kbenson@cdc.gov

770-488-0684

Thank you for participating!