Epidemiological Research Request

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Epidemiological Research Request -- Federal Entities	Form and Instruction	Removed	Available
Addendum - 0701.doc	Supplementary Document	Uploaded 2010-12-03	Available
Supporting Statement - 0701.doc	Supporting Statement A	Uploaded 2011-01-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9755	Epidemiological Research Request -- State and Local Government	Other-Internet Screens	Modified
183744	Epidemiological Research Request -- Federal Entities	Form and Instruction	Removed
183743	Epidemiological Research Request -- Private Entities	Other-Internet Screens	Modified

ICR Details

OMB Control No: 0960-0701	ICR Reference No: 201010-0960-004
Status: Historical Active	Previous ICR Reference No: 200802-0960-004
Agency/Subagency: SSA	Agency Tracking No:
Title: Epidemiological Research Request
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/17/2011
	Date Received in OIRA: 02/10/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2014	36 Months From Approved	04/30/2011
Responses	28	0	30
Time Burden (Hours)	56	0	60
Cost Burden (Dollars)	102,620	0	0

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Abstract: Section 311 of the Social Security Independence and Program Improvements Act of 1994 directed SSA to provide support to health researchers involved in epidemiological research. Specifically, when SSA determines a study will contribute to a national health interest, the agency will furnish information to determine whether a study subject is shown on the SSA administrative records as being alive or deceased (vital status). SSA will recoup all expenses incurred in providing this information. Web-posted questions solicit the information SSA needs to provide the data and to collect the fees. The requestors are scientific researchers who are applying to receive vital status information about individuals from Social Security administrative data records.

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Authorizing Statute(s): US Code: 5 USC 552a Name of Law: Social Security Act
   US Code: 42 USC 1306 Name of Law: Social Security 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:
	75 FR 69516	11/12/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 5233	01/28/2011
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
Epidemiological Research Request -- State and Local Government
Epidemiological Research Request -- Private Entities
Epidemiological Research Request -- Federal Entities	N/A	Epidemiological Research Review

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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	28	30	0	-2	0	0
Annual Time Burden (Hours)	56	60	0	-4	0	0
Annual Cost Burden (Dollars)	102,620	0	0	0	102,620	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: We removed the burden for Federal Entities. We inadvertently included them in the last submission of this ICR, and are correcting for that now.

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Annual Cost to Federal Government: $121,000

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 02/10/2011

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