Nuclear Test Personnel Review Forms

Forms and Documents

Document Name	Status
Form DTRA Form 150 Nuclear Test Personnel Review Forms Form	Unchanged
Supporting Statement.doc Supporting Statement A	2011-04-01

IC Document Collections

IC ID	Document Title	Status
181351	Nuclear Test Personnel Review Forms Form	Unchanged

ICR Details

OMB Control No: 0704-0447	ICR Reference No: 201104-0704-001
Status: Historical Active	Previous ICR Reference No: 200802-0704-001
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Nuclear Test Personnel Review Forms
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/03/2011
	Date Received in OIRA: 04/01/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2014	36 Months From Approved	05/31/2011
Responses	370	0	370
Time Burden (Hours)	463	0	463
Cost Burden (Dollars)	11,563	0	11,563

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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): US Code: 38 USC 1112 Name of Law: null
   US Code: 38 USC 1154 Name of Law: null
   US Code: 42 USC 2210 Name of Law: null
   PL: Pub.L. 98 - 542 xxx Name of Law: null
  

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

IC Title	Form No.	Form Name
Nuclear Test Personnel Review Forms	DTRA Form 150-C, DTRA Form 150-B, DTRA Form 150, DTRA Form 150-A	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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ICR Summary 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	370	370	0	0	0	0
Annual Time Burden (Hours)	463	463	0	0	0	0
Annual Cost Burden (Dollars)	11,563	11,563	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: $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]? 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: 04/01/2011

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