VA Cooperative Study Project #500A, National Registry of Veterans with Amyotrophic Lateral Sclerosis (ALS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0649 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 10-21047a VA Cooperative Study Project #500A, National Registry of Veterans with Amyotrophic Lateral Sclerosis (ALS) Form
VA Form 10-21047 ALS Registry Screening Form 2900-0649 VAF 10-21047 v2.doc Form
VA Form 10-21047a Biannual Telephone Interview, National Registry of Veter 2900-0649 VAF 10-21047a.doc Form
VA Form 10-21047b Verbal Informed Consent VIA Telephone, National Registry 2900-0649 VAF 10-21047b.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	VA Cooperative Study Project #500A, National Registry of Veterans with Amyotrophic Lateral Sclerosis (ALS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	VA Form 10-21047a	Biannual Telephone Interview, National Registry of Veterans with ALS	2900-0649 VAF 10-21047a.doc	No	Paper Only
Form	VA Form 10-21047	ALS Registry Screening Form	2900-0649 VAF 10-21047 v2.doc	No	Paper Only
Form	VA Form 10-21047b	Verbal Informed Consent VIA Telephone, National Registry of Veterans with ALS	2900-0649 VAF 10-21047b.doc	No	Paper Only

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,715	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,740	-1,082	0	3,822
Annual IC Time Burden (Hours)	1,296	0	-512	1,808
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.