PREDICT Change Burden Accounting Workbook

IC Title	Status	Document Title	Proposed Changes	Burden (minutes)	Annual Respondents	Annual Burden (hours)	Annual Cost ($100/hour)	Document Type	Form Number
Account Request Form	Modified	PREDICT Account Request (Join the Community)	Reduction of data collected - Removed request for address information and for multiple phone numbers. Added request to new user to indicate where he/she heard about PREDICT (info box w/radio buttons)	15	45	11.25	$1,125.00	Form and Instruction	DHS Form 10029 (12/07)
Request a Dataset Form	Modified	Request Dataset (Request Selected Datasets)	Addition of a field for location of research and replace a text box with fields to input names of research team members.	15	15	3.75	$375.00	Form and Instruction	DHS Form 10032 (12/07)
My Datasets	No Change	My Datasets	None. Desire to extend approval to use to coincide with other forms.	15	30	7.5	$750.00	Form and Instruction	DHS Form 10033 (12/07)
Memorandum of Agreement - PREDICT (PCC) Coordinating Center and Principal Researcher	Modified	Memorandum of Agreement - Principal Researcher	Propose to split the currently approved form into two documents with new scopes and different signatories. The updated form will be for Principal Researchers when applying for datasets for individual research.	60	15	15	$1,500.00	Form and Instruction	DHS Form 10035 (12/07)
Memorandum of Agreement PREDICT Coordinating Center (PCC) and Data Provider (DP)	Modified	Memorandum of Agreement - Data Provider	Proposed changes to MOA provisions, but no changes to data required.	45	2	1.5	$150.00	Form and Instruction	DHS Form 10036 (12/07)
Memorandum of Agreement PREDICT Coordinating Center (PCC) and Data Host (DH)	Modified	Memorandum of Agreement - Data Host	Proposed changes to MOA provisions, but no changes to data required.	45	1	0.75	$75.00	Form and Instruction	DHS Form 10037 (12/07)
Authorization Letter for Data Host	Removed	Authorization Letter for Data Host	None. Form is deprecated. Propose retiring the form.	0	0	0	0	Form and Instruction	DHS Form 10038 (12/07)
Authorization Letter for Data Provider	Removed	Authorization Letter for Data Provider	None. Form is deprecated. Propose retiring the form.	0	0	0	0	Form and Instruction	DHS Form 10039 (12/07)
Sponsorship Letter	Modified	PREDICT Referring Letter	Will rename to Referring Letter and add data collection fields	60	45	45	$4,500.00	Form and Instruction	DHS Form 10040 (12/07)
Notice of Dataset Access/Application Expiration	Removed	Notice of Data Request Extension	None. Form is deprecated. Propose retiring the form.	0	0	0	0	Form and Instruction	DHS Form 10041 (12/07)
Notice for Certificate of Data Destruction	Modified	Notice for Certificate of Disposal	Rename to Notice of Data Disposal	15	15	3.75	$375.00	Form and Instruction	DHS Form 10042 (12/07)
Amendment to Researcher/User Agreement	Modified	Amendment to Principal Researcher MOA	Proposed changes to the provisions; creates a separate amendment for the new separate Principal Researcher MOA.	15	15	3.75	$375.00	Form and Instruction	DHS Form 10060 (12/07)
Notice of Data Access Expiration	Modified	Notice of MOA & Data Access Expiration	Text update not data collection related.	15	15	3.75	$375.00	Form and Instruction	DHS Form 10061 (12/07)
Dataset Proposal Submission	New	Dataset Proposal Submission	New	15	15	3.75	$375.00	Form and Instruction	DHS Form 10074(New#1)
Memorandum of Agreement Research Organization	New	Memorandum of Agreement - Research Organization	MOA for Research Organizations to request datasets and appoint data custodian(s) for a specific project.	60	15	15	$1,500.00	Form and Instruction	DHS Form 10075(New#2)
My Datasets Requests Page	New	My Dataset Requests	New. Provides features to: 1. Confirm receipt of datasets. 2. Request more datasets in an approved category. 3. Request an MOA amendment to add members to the research team.	15	15	3.75	$375.00	Form and Instruction	DHS Form 10076(New#3)
Amendment to Research Organization Memorandum of Agreement	New	Amendment to Research Organization MOA	New. Provides features to: 1. Confirm receipt of datasets. 2. Request more datasets in an approved category. 3. Request an MOA amendment to add members to the research team.	15	15	3.75	$375.00	Form and Instruction	DHS Form 10077(New#4)
				TOTALS	258	122.25	$12,225.00
			Average Burden per Respondent			0.5