Creation of State and Metropolitan Area Based Surveillance Projects for Amyotrophic Lateral Sclerosis (ALS)

ICR 201111-0923-002

OMB: 0923-0043

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Form
Modified
Supplementary Document
2011-11-14
Supplementary Document
2011-11-14
Justification for No Material/Nonsubstantive Change
2011-11-14
IC Document Collections
IC ID
Document
Title
Status
196100 Modified
196099 Modified
196098 Modified
196097 Modified
ICR Details
0923-0043 201111-0923-002
Historical Active 201102-0923-001
HHS/TSDR
Creation of State and Metropolitan Area Based Surveillance Projects for Amyotrophic Lateral Sclerosis (ALS)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 01/06/2012
Retrieve Notice of Action (NOA) 11/15/2011
Previous TOC apply.
  Inventory as of this Action Requested Previously Approved
04/30/2014 04/30/2014 04/30/2014
3,186 0 3,186
703 0 703
0 0 0

This nonsubstantive change request is to notify OMB of the three additional sites that were selected for this project, as per terms of clearance.

PL: Pub.L. 110 - 280 S1382 Name of Law: Amendment to the Public Health Service Act
  
None

Not associated with rulemaking

No

4
IC Title Form No. Form Name
ALS Case Reporting Form none Case Reporting Form
ALS Medical Record Verification Form none Medical Record Verification Form
Training for Reporting
Line Listing

  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 3,186 3,186 0 0 0 0
Annual Time Burden (Hours) 703 703 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$2,765,000
Yes Part B of Supporting Statement
Yes
No
No
No
Uncollected
Daniel Holcomb 770 488-4472 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
11/15/2011


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