Long-Term Efficacy of a Program to Prevent Beryllium Disease

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Response to OMB 0920-07AY_2008Feb21.doc	Supporting Statement B	Uploaded 2008-03-20	Available
Appendix F 308 Approval .pdf	Supplementary Document	Uploaded 2007-10-12	Available
NIOSH Prevent Be Appendix D.pdf	Supplementary Document	Uploaded 2007-10-12	Available
NIOSH Prevent Be Appendix C 60 day FRN.pdf	Supplementary Document	Uploaded 2007-10-12	Available
NIOSH DRDS Appendix A Prevent Be Disease 29 usc 669.doc	Supplementary Document	Uploaded 2007-10-12	Available
NIOSH DRDS Prevent Be Disease Part A of SS Sept. 20 revision.doc	Supporting Statement A	Uploaded 2007-10-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
182449	Consent to Participate and Authorization for Release of Information	Other-Consent Document	New
182448	Medical and Work History Questionnaire	Other-Computer Assisted Survey	New

ICR Details

OMB Control No: 0920-0771	ICR Reference No: 200710-0920-009
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Long-Term Efficacy of a Program to Prevent Beryllium Disease
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: Approved with change	Conclusion Date: 03/24/2008
	Date Received in OIRA: 10/24/2007
Terms of Clearance: Approved consistent with CDC responses to OMB questions and comments.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2011	36 Months From Approved
Responses	386	0	0
Time Burden (Hours)	193	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Beryllium is a lightweight metal with many applications. Exposed workers may be found in the primary production, nuclear power and weapons, aerospace, scrap metal reclamation, speciality ceramics, and electronics industries, among others. Exposure to Beryllium can lead to sensitization and cause immunologic granulomatous lung disease. This proposed study is designed to evaluate the effectiveness of a comprehensive preventive program at three beryllium plants.

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Authorizing Statute(s): US Code: 42 USC 306 Name of Law: Public Health Service Act
   US Code: 42 USC 308(d) Name of Law: Public Health Service Act
   US Code: 29 USC 669 Name of Law: Occupational Safety and Health
   US Code: 42 USC 241 Name of Law: Public Health Service Act
   US Code: 30 USC 501 Name of Law: Public Health Service Act
  

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 21022	04/27/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 57581	10/10/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Consent to Participate and Authorization for Release of Information
Medical and Work History Questionnaire

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	386	0	0	386	0	0
Annual Time Burden (Hours)	193	0	0	193	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: This is a new data collection.

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Annual Cost to Federal Government: $350,206

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 10/23/2007

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