Registration of Individuals Displaced by Hurricanes Katrina and Rita (Pilot Project)

Forms and Documents

Document Name	Status
Questionnaire Form	New
Screening Questionnaire Form	New
Resubmission_ICR#0923-09BK_OMB Supporting Statement B_ Katrina Registry_ Dec 20 2011.doc Supporting Statement B	2012-02-06
Resubmission_ICR#0923-09BK_Appendix O_Proposed Billboards.pdf Supplementary Document	2012-02-06
Resubmission_ICR#0923-09BK_Appendix N_Print Advertisement.pdf Supplementary Document	2012-02-06
Resubmission_ICR#0923-09BK_Appendix M_Brochure.pdf Supplementary Document	2012-02-06
Resubmission_ICR#0923-09BK_Appendix L_Reminder Postcard.doc Supplementary Document	2012-02-06
Resubmission_ICR#0923-09BK_Appendix K_Outreach Website contents and FAQs.doc Supplementary Document	2012-02-06
Resubmission_ICR#0923-09BK_Appendix J_Outreach Plan Outline.doc Supplementary Document	2012-02-06
Resubmission_ICR#0923-09BK_Appendix I_Power Calculations.doc Supplementary Document	2012-02-06
Resubmission_ICR#0923-09BK_Appendix H_Sampling Plan.docx Supplementary Document	2012-02-06
Resubmission_ICR#0923-09BK_Appendix G_CDC IRB Approval Letter Dated Oct 21 2011.docx Supplementary Document	2012-02-06
Resubmission_ICR#0923-09BK_Appendix D_Letter of Introduction_Trailer Occupants.doc Supplementary Document	2012-02-06
Resubmission_ICR#0923-09BK_Appendix C_Access Controls_Dec 19 2011 Ver.doc Supplementary Document	2012-02-06
Resubmission_ICR#0923-09BK_Appendix B_60-day Federal Register Notice_Published April 13 2009.doc Supplementary Document	2012-02-06
Resubmission_ICR#0923-09BK_Appendix A_Authorizing Legislation.doc Supplementary Document	2012-02-06
Resubmission_ICR#0923-09BK_OMB Supporting Statement A_Katrina Registry_Dec 20 2011.doc Supporting Statement A	2012-02-06

IC Document Collections

IC ID	Document Title	Status
201175	Questionnaire Form	New
201174	Screening Questionnaire Form	New

ICR Details

OMB Control No: 0923-0045	ICR Reference No: 201202-0923-001
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/TSDR	Agency Tracking No:
Title: Registration of Individuals Displaced by Hurricanes Katrina and Rita (Pilot Project)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 05/08/2012
	Date Received in OIRA: 02/13/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		24 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: After Hurricanes Katrina and Rita struck the Gulf Coast in 2005, some 275,000 persons occupied temporary housing units supplied by FEMA. These persons may have been exposed to levels of formaldehyde sufficient to arouse concern about the health impact. We propose to develop a pilot registry to serve as a comprehensive basis for short-term health surveillance, and allow FEMA and ATSDR to provide information to the affected population about health concerns and efforts to address those concerns. The registry will consist of people who occupied FEMA supplied temporary housing after hurricanes Katrina and Rita. CATI technology will be used to collect data.

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Authorizing Statute(s): US Code: 42 USC 104 Name of Law: CERCLA
  

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:
	74 FR 16874	04/13/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 6801	02/09/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Screening Questionnaire	none	Katrina Registry Pilot Screener
Questionnaire	none	Questionnaire

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR.

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Annual Cost to Federal Government: $1,726,771

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: 02/13/2012

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