Justification Memo

Justification Memo_11.22.11.docx

Countermeasures Injury Compensation Program (CICP)

Justification Memo

OMB: 0915-0334

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DATE: November 22, 2011


FROM: Reports Clearance Officer, HRSA


TO: Office of Information and Regulatory Affairs, OMB


SUBJECT: HRSA Request for Non-Substantive Change to the Countermeasures Injury Compensation Program (OMB Control No. 0915-0334)


The Health Resources and Services Administration (HRSA) is requesting Office of Management and Budget (OMB) review and approval of a non-substantive change to the Countermeasures Injury Compensation Program (CICP) information collection package. This change specifically relates to the CICP Requests for Benefits Form that is included as an instrument in the package.


In light of the recent crackdown concerning the security of PII and PHI, HRSA wishes to remove the field where the respondents’ Social Security Numbers are requested on the form, as it is no longer necessary to their data collection.  This is the only change to the Request for Benefits Form, on sections A and B, as well as to the instructions to reflect those changes.


Please let me know if you have any questions concerning this request.



Thank you.


Carla Haddad




Carla Haddad, MPH

Public Health Analyst

Office of Planning, Analysis and Evaluation

Health Resources and Services Administration

5600 Fishers Lane, Rm 10-49

Rockville, MD 20857

Phone: (301) 443-0165

Email: [email protected]




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