State Surveillance under the National Toxic Substance Incidents Program (NTSIP)

Forms and Documents

Document Name	Status
Data Collection for Poison Control Centers Form	New
Data Collection for Hospitals Form	New
Data Collection for Other State and Local Governments Form	New
Data Collection for Responsible Party Form	New
Data Collection for Emergency Government Services Form	New
Data Collection for On-scene Commanders Form	New
Data Collection for State NTSIP Coordinators Form	New
Modified NTSIP reports intranet page 20140730.docx Supplementary Document	2014-09-16
Modified NTSIP 2011DictionaryWEB_20140721.doc Supplementary Document	2014-09-16
Modified NTSIP 2010DictionaryWEB_20140721.doc Supplementary Document	2014-09-16
AttK_RsrchDet_03.27.14.pdf Supplementary Document	2014-09-16
AttG_DecisionTree 07.30.14.pptx Supplementary Document	2014-09-16
AttF_TrainingManual_07.30.14.doc Supplementary Document	2014-09-16
AttK_RsrchDet.pdf Supplementary Document	2014-04-03
AttJ_Stakeholders.docx Supplementary Document	2014-04-03
AttI_DataShareAgree.doc Supplementary Document	2014-04-03
AttH_DataItems.docx Supplementary Document	2014-04-03
AttG_DecisionTree.docx Supplementary Document	2014-04-03
AttF_TrainingManual.doc Supplementary Document	2014-04-03
AttD_DataCollForm_Word.docx Supplementary Document	2014-04-03
AttC_DataCollFlowchart.pptx Supplementary Document	2014-04-03
AttB_60DayFRN.pdf Supplementary Document	2014-04-03
AttA_AuthLeg.doc Supplementary Document	2014-04-03
NTSIP_SuppStmt_B_04.01.14.docx Supporting Statement B	2014-09-16
NTSIP_SuppStmt_A_07_16_14.docx Supporting Statement A	2014-09-16

IC Document Collections

IC ID	Document Title	Status
211103	Data Collection for Poison Control Centers Form	New
211102	Data Collection for Hospitals Form	New
211101	Data Collection for Other State and Local Governments Form	New
211100	Data Collection for Responsible Party Form	New
211099	Data Collection for Emergency Government Services Form	New
211098	Data Collection for On-scene Commanders Form	New
211096	Data Collection for State NTSIP Coordinators Form	New

ICR Details

OMB Control No: 0923-0050	ICR Reference No: 201404-0923-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/TSDR	Agency Tracking No:
Title: State Surveillance under the National Toxic Substance Incidents Program (NTSIP)
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: Approved with change	Conclusion Date: 09/16/2014
	Date Received in OIRA: 04/10/2014
Terms of Clearance: CDC agrees that in all publications the following disclaimer must be made “NTSIP states use a variety of available data sources and reporting procedures to complete the incident form. Aggregating data across states and across incidents should be interpreted with caution.” In any publication where national estimates are used an additional statement must be included “The lack of uniform reporting methods is a limitation in making national estimates.”

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2017	36 Months From Approved
Responses	2,363	0	0
Time Burden (Hours)	1,821	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: NTSIP gather information about spills and leaks of toxic substances as it coordinates the collection, collagtion , analysis and distribution of acute toxic substance incidents data. This system will be incident-driven. The coordinators will collect data from existing sources and conduct interviews to gather remaining information about a spill or leak.

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Authorizing Statute(s): US Code: 42 USC 103 Name of Law: CERCLA and SARA
  

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:
	78 FR 79696	12/31/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 19336	04/08/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

IC Title	Form No.	Form Name
Data Collection for Emergency Government Services	none	Data Collection for Emergency Government Services
Data Collection for Responsible Party	none	Data Collection for Responsible Party
Data Collection for Other State and Local Governments	none	Data Collection for Other State and Local Governments
Data Collection for Hospitals	none	Data Collection for Hospitals
Data Collection for State NTSIP Coordinators	none	Data Collection for State NTSIP Coordinators
Data Collection for Poison Control Centers	none	Data Collection for Poison Control Centers
Data Collection for On-scene Commanders	none	Data Collection for On-scene Commanders

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ICR Summary 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	2,363	0	0	2,363	0	0
Annual Time Burden (Hours)	1,821	0	0	1,821	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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: No

Burden Reduction Due to:

Short Statement: This is a new ICR.

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Annual Cost to Federal Government: $770,212

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? 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

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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: 04/10/2014

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