Voluntary Survey Modules

National Amyotrophic Lateral Sclerosis (ALS) Registry

OMB: 0923-0041

IC ID: 192031

Information Collection (IC) Details

View Information Collection (IC)

Voluntary Survey Modules
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Voluntary ALS Survey Modules Attach_6-Approved Surveys (screenshots)-with OMB box.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances  76 FR 4432

750 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 750 0 -11,250 0 0 12,000
Annual IC Time Burden (Hours) 1,000 0 0 0 0 1,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
ALS Functional Rating Scale Attach_6A-Scoring ALSFRS final.docx 06/22/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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