Information Collection

ALS Registration

IC 192030 under ICR 201305-0923-004 · OMB 0923-0041.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0041 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ALS Registration	Form
ALS Registry Registration Attach_5-Screen Shot Registration Page.docx	Form
Attachment 8 - Screen Shot Consent Form-revised.docx 8 - Consent Form	IC Document

IC Title:

ALS Registration

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	ALS Registry Registration	Attach_5-Screen Shot Registration Page.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances, 09-19-0001

FR Citation: 59 FR 67085

Number of Respondents: 1,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,500	-3,167	4,667
Annual IC Time Burden (Hours)	175	-369	544
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
8 - Consent Form	Attachment 8 - Screen Shot Consent Form-revised.docx	05/02/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.