Tremolite Asbestos Registry

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form No number Tremolite Asbestos Registry - Baseline Surveys	Form	Modified	Available
Form No number Adult and Child Follow-Up	Form	New	Available
Reinstatement09230039Supporting Statement TAR 2009 Section B (4).doc	Supporting Statement B	Uploaded 2009-09-02	Available
Appendix H (Consent Health Information).doc	Supplementary Document	Uploaded 2009-09-02	Available
Appendix G (Consent Forms).doc	Supplementary Document	Uploaded 2009-09-02	Available
Appendix F (IRB approval).doc	Supplementary Document	Uploaded 2009-09-02	Available
Appendix C (TAR Privacy Impact Assessment).doc	Supplementary Document	Uploaded 2009-09-02	Available
Appendix B (60 Day Notice).doc	Supplementary Document	Uploaded 2009-09-02	Available
Appendix A (Legislative Mandate).doc	Supplementary Document	Uploaded 2009-09-02	Available
ReinstatementSupporting_Statement_TAR_2009_Section_A_edit.doc	Supporting Statement A	Uploaded 2010-03-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43624	Tremolite Asbestos Registry - Baseline Surveys	Form	Modified
190823	Adult and Child Follow-Up	Form	New

ICR Details

OMB Control No: 0923-0039	ICR Reference No: 200909-0923-001
Status: Historical Active	Previous ICR Reference No: 200509-0923-001
Agency/Subagency: HHS/TSDR	Agency Tracking No:
Title: Tremolite Asbestos Registry
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/04/2010
	Date Received in OIRA: 09/28/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2013	36 Months From Approved	03/31/2010
Responses	2,000	0	1,500
Time Burden (Hours)	1,000	0	680
Cost Burden (Dollars)	0	0	0

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Abstract: The Tremolite Asbestos Registry (TAR) is currently authorized as part of the National Exposure Registry (0923-0006). ATSDR is requesting separate approval for the TAR activities. The purpose of the TAR is to improve communication with people at risk for developing asbestos-related disease resulting from asbestos exposure in Libby, Montana, and to support research activities related to TAR registrants. The registry includes an initial base line questionnaire and a follow-up questionnaire every 3 years. All information will be collected electronically.

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Authorizing Statute(s): PL: Pub.L. 96 - 510 104(i)(1) Name of Law: Comprehensive Environmental Response, Compensation and Liability 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:
	74 FR 21369	05/07/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 46775	09/11/2009
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
Tremolite Asbestos Registry - Baseline Surveys	No number	TAR Adult and Child Baseline Surveys
Adult and Child Follow-Up	No number	TAR Adult and Child Follow-up Survey

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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	2,000	1,500	0	0	500	0
Annual Time Burden (Hours)	1,000	680	0	250	70	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $113,219

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)? No

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: 09/28/2009

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