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	Available
SORN - HDTRA 010 10.27.2017.docx	Supplementary Document	Uploaded 2017-10-27	Available
DOD_Radiation_&_Secrecy_Agreements[1].pdf	Supplementary Document	Uploaded 2017-10-27	Available
9.13 DTRA_150_response_memo_signed.pdf	Supplementary Document	Uploaded 2017-10-27	Available
OIM Review 09.13.2017 SS-A.doc	Supporting Statement A	Uploaded 2017-10-27	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: 201710-0704-005
Status: Active	Previous ICR Reference No: 201405-0704-002
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Nuclear Test Personnel Review Forms
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/27/2017
	Date Received in OIRA: 10/27/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2020	36 Months From Approved
Responses	86	0	0
Time Burden (Hours)	71	0	0
Cost Burden (Dollars)	1,574	0	0

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Abstract: DTRA collects this information to provide verification of participation and/or radiation dose assessment for atomic veterans seeking radiogenic disease compensation from the VA (Veterans Affairs) or DOJ (Department of Justice).

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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: The Veterans' Dioxin and Radiation Exposure Compensation Standards Act
  

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:
	82 FR 32348	07/13/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 49792	10/27/2017
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 ,   Nuclear Test Personnel Review Program: Questionnaire for Continental United States Test Participants ,   Nuclear Test Personnel Review Program: Questionnaire for Oceanic Test Participants ,   Nuclear Test Personnel Review Program: 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	86	0	0	-284	0	370
Annual Time Burden (Hours)	71	0	0	-392	0	463
Annual Cost Burden (Dollars)	1,574	0	0	-9,989	0	11,563

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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The burden has decreased since the previous approval due to the decreasing number of claims being filed and process improvements lowering the requirements for this collection.

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Annual Cost to Federal Government: $15,857

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 10/27/2017

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