Chronic Beryllium Disease Prevention Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DOE F 440-1 Signed Consent Forms for Medical Exams	Form and Instruction	Modified	Available
30 Day FRN Published 11-20-2012.pdf	Supplementary Document	Uploaded 2012-12-26	Available
60 day FRN published 9-7-12.pdf	Supplementary Document	Uploaded 2012-12-26	Available
Revised 2012 ICR Supporting Statement RLSO 6-10-14.doc	Supporting Statement A	Uploaded 2014-06-12	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
45148	Maintain Beryllium Registry		Modified
45145	Annual Performance Feedback		Modified
45142	Annual Recordkeeping		Modified
45140	Signed Consent Forms for Medical Exams	Form and Instruction	Modified
45139	Worker Notification of Monitoring Results		Modified
23435	Annual Revisions to CBDPP Plans		Modified

ICR Details

OMB Control No: 1910-5112	ICR Reference No: 201212-1910-002
Status: Historical Active	Previous ICR Reference No: 200909-1910-001
Agency/Subagency: DOE/DOEOA	Agency Tracking No: Felecia Briggs
Title: Chronic Beryllium Disease Prevention Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/16/2014
	Date Received in OIRA: 12/27/2012
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is approved for three years.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2017	36 Months From Approved	06/30/2014
Responses	15,881	0	29,693
Time Burden (Hours)	25,036	0	25,024
Cost Burden (Dollars)	1,293,623	0	1,227,720

---

Abstract: DOE and DOE contractors will use this information collecton to manage chronic beryllium disease prevention programs, provide information to employees, and facilitate DOE ovesight of the programs.

---

Authorizing Statute(s): US Code: 42 USC 7191 and 7524 Name of Law: Department of Energy Organization Act
   US Code: 42 USC 2201 Name of Law: Atomic Energy Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1901-AA99	Final or interim final rulemaking	71 FR 27	02/09/2006

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 55197	09/07/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 69613	11/20/2012
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Maintain Beryllium Registry
Signed Consent Forms for Medical Exams	DOE F 440-1	Chronic Beryllium Disease Prevention Program Informed Consent
Annual Recordkeeping
Annual Performance Feedback
Annual Revisions to CBDPP Plans
Worker Notification of Monitoring Results

---

ICR Summary of Burden

table that charts list 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	15,881	29,693	0	-13,812	0	0
Annual Time Burden (Hours)	25,036	25,024	0	12	0	0
Annual Cost Burden (Dollars)	1,293,623	1,227,720	0	65,903	0	0

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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This ICR submission is for re-approval of an existing ICR and DOE expects all initial requirements to have been completed. Thus, only annual recurring costs have been included in this ICR.

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

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

---

Common Form ICR:  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:

(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: 12/27/2012

---