Nuclear Test Personnel Review Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DTRA Form 150-C Questionnaire for Crossroads Test Participants	Form	New	Available
Form DTRA Form 150-B Questionnaire for Oceanic Test Participants	Form	New	Available
Form DTRA Form 150-A Questionnaire for Continental United States Test Participants	Form	New	Repair queued
Form DTRA Form 150 Nuclear Test Personnel Review Information Request and Release	Form	New	Available
DTRA NTPR Forms - Supporting Statement for OMB 83-I - 30 May 2007.doc	Supporting Statement A	Uploaded 2007-07-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
181351	Nuclear Test Personnel Review Forms	Form	New	Questionnaire for Crossroads Test Participants
181351	Nuclear Test Personnel Review Forms	Form	New	Questionnaire for Oceanic Test Participants
181351	Nuclear Test Personnel Review Forms	Form	New	Questionnaire for Continental United States Test Participants
181351	Nuclear Test Personnel Review Forms	Form	New	Nuclear Test Personnel Review Information Request and Release

ICR Details

OMB Control No: 0704-0447	ICR Reference No: 200707-0704-002
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: DOW/DODDEP	Agency Tracking No:
Title: Nuclear Test Personnel Review Forms
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 11/26/2007
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/30/2007
Terms of Clearance: DOD should resubmit the collection once the revised materials are in place.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The collection of this information is necessary to provide verification of participation and/or radiation dose assessment for atomic veterans seeking radiogenic disease compensation form the VA or DOJ.

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Authorizing Statute(s): PL: Pub.L. 98 - 542 xxx
   US Code: 38 USC 1112
   US Code: 38 USC 1154
   US Code: 42 USC 2210
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 4246	01/30/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 30556	06/01/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Nuclear Test Personnel Review Forms	DTRA Form 150, DTRA Form 150-A, DTRA Form 150-C, DTRA Form 150-B	Nuclear Test Personnel Review Information Request and Release ,   Questionnaire for Continental United States Test Participants ,   Questionnaire for Oceanic Test Participants ,   Questionnaire for Crossroads Test Participants

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: New Collection

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Annual Cost to Federal Government: $74,300

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/30/2007

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