Morbidity Study of Former Marines, Dependents, and Employees Potentially Exposed to Contaminated Drinking Water at USMC Base Camp Lejeune

Forms and Documents

Document Name	Status
Health Survey Form	Modified
Camp Lejeune Podcast Transcript.pdf Supplementary Document	2011-09-26
CDC Protocol#5536-Amendment_10-Exp.doc Supplementary Document	2011-09-22
CDC Protocol #5536 incident report #1.doc Supplementary Document	2011-09-22
ICR#0923-0042_Appendix 10 Next-Of-Kin_Correction Letter formatted.pdf Supplementary Document	2011-09-22
ICR#0923-0042_OMB change memo NOK correction letter.doc Justification for No Material/Nonsubstantive Change	2011-09-22
Attachment E Letters of invitation from ATSDR April 2011.doc Supplementary Document	2011-04-25
Attachment M Consent for registrants April 2011 redline.doc Supplementary Document	2011-04-14
Attachment L Consent for Health Study participnats April 2011.doc Supplementary Document	2011-04-14
Attachment K telephone reminder 2_11 clean.doc Supplementary Document	2011-04-14
Attachment J email reminder 2_11 clean.doc Supplementary Document	2011-04-14
Attachment I reminder letter 2_11 clean.doc Supplementary Document	2011-04-14
Attachment H email reminder 2_11 clean.doc Supplementary Document	2011-04-14
Attachment G postcard 2_11 clean.doc Supplementary Document	2011-04-14
Attachment F email invite 2_11 clean.doc Supplementary Document	2011-04-14
Attachment D prenotice and invite ltr USMC 2_11 clean.docx Supplementary Document	2011-04-14

IC Document Collections

IC ID	Document Title	Status
195214	Health Survey Form	Modified

ICR Details

OMB Control No: 0923-0042	ICR Reference No: 201109-0923-001
Status: Historical Active	Previous ICR Reference No: 201104-0923-001
Agency/Subagency: HHS/TSDR	Agency Tracking No:
Title: Morbidity Study of Former Marines, Dependents, and Employees Potentially Exposed to Contaminated Drinking Water at USMC Base Camp Lejeune
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/26/2011
	Date Received in OIRA: 09/22/2011
Terms of Clearance: Previous terms of clearance apply.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2013	11/30/2013	11/30/2013
Responses	47,601	0	47,601
Time Burden (Hours)	35,701	0	35,701
Cost Burden (Dollars)	0	0	0

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Abstract: This change request is to correct an error made on the survey forms mailed to next-of-kin of deceased persons who were at Camp LeJeune. A letter from the PIs has been prepared to mail to 17,000 next-of-kin.

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Authorizing Statute(s): PL: Pub.L. 110 - 181 315 Name of Law: National Defense Authorization 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

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
Health Survey	none	Health Survey

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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	47,601	47,601	0	0	0	0
Annual Time Burden (Hours)	35,701	35,701	0	0	0	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: $4,900,000

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? Yes

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: 09/22/2011

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