Where I live, they test for lead at one and two years via bloodwork.
I didn't decline for my first son because we lived in a pre-WWII apartment... and the paint was chipped in places.
I would have declined for my second son had the red Thomas trains recall not have taken place. Because we had over 1/2 of the items being recalled
I felt better to be safe than sorry.
DS1 was a very hard stick... phlebotomists (4 different ones!) tried both of his arms, as well as legs before finally getting a vein. Very traumatic. He just had blood work a few days ago, and is still a hard stick. Our ped ended up taking it off the top of his foot. Traumatic for everybody.
DS2 is the complete opposite...an easy stick. One try, not much crying from him either.
I think if we had been living in a new house and the Thomas recall hadn't occurred, I probably would have skipped the bloodwork.