Nuclear Test Personnel Review Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DTRA Form 150 Nuclear Test Personnel Review Forms	Form	Modified	Repair queued
2014 05 07 - DTRA Form(s) 150 - Supporting Statement B.doc	Supporting Statement B	Uploaded 2014-05-23	Available
DOD_Radiation_&_Secrecy_Agreements[1].pdf	Supplementary Document	Uploaded 2014-05-21	Repair queued
SORN - HDTRA 010.pdf	Supplementary Document	Uploaded 2014-05-20	Available
2014 04 15 - SSN Justification for DTRA Form 150.pdf	Supplementary Document	Uploaded 2014-05-20	Available
PIA_Sections 1 - 2.pdf	Supplementary Document	Uploaded 2014-05-20	Repair queued
DTRA Form(s) 150 - Supporting Statement A_05-23-14.doc	Supporting Statement A	Uploaded 2014-05-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
181351	Nuclear Test Personnel Review Forms	Form	Modified

ICR Details

OMB Control No: 0704-0447	ICR Reference No: 201405-0704-002
Status: Historical Active	Previous ICR Reference No: 201104-0704-001
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Nuclear Test Personnel Review Forms
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/24/2014
	Date Received in OIRA: 05/23/2014
Terms of Clearance:

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	370	0	370
Time Burden (Hours)	463	0	463
Cost Burden (Dollars)	11,563	0	11,563

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Abstract: The collection of this information is necessary to provide verification of participation and/or radiation dose assessment for atomic veterans seeking radiogenic disease compensation form the VA or DOJ.

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Authorizing Statute(s): US Code: 38 USC 1112 Name of Law: null
   US Code: 38 USC 1154 Name of Law: null
   US Code: 42 USC 2210 Name of Law: null
   PL: Pub.L. 98 - 542 xxx Name of Law: null
  

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:
	79 FR 14240	03/13/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 29747	05/23/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Nuclear Test Personnel Review Forms	DTRA Form 150, DTRA Form 150-A, DTRA Form 150-C, DTRA Form 150-B	Nuclear Test Personnel Review Information Request and Release ,   Questionnaire for Continental United States Test Participants ,   Questionnaire for Oceanic Test Participants ,   Questionnaire for Crossroads Test Participants

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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	370	370	0	0	0	0
Annual Time Burden (Hours)	463	463	0	0	0	0
Annual Cost Burden (Dollars)	11,563	11,563	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $74,300

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

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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: 05/23/2014

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