Spinal Muscular Atrophy (SMA) Proficiency Testing (PT) Pilot

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Spinal Muscular Atrophy (SMA) Proficiency Testing (PT) Pilot Form and Instruction
Data Reporting Page Attachment A - Pilot Online Data Collection for SMA PT Screenshot of Data Reporting Page.pdf Form and Instruction
Feedback Form Attachment B - Pilot Online Data Collection for SMA PT Feedback Form.xlsm Form and Instruction
Attachment C - Pilot Online Data Collection for SMA PT Research Determination.pdf Research Determination IC Document
Attachment D - Pilot Online Data Collection for SMA PT Email Invitation.docx Email invitation IC Document
Attachment E - Pilot Online Data Collection for SMA PT Email Packet.docx Email packet IC Document
Attachment F - Pilot Online Data Collection for SMA PT Email Reminder.pdf Email reminder IC Document
Attachment G - Pilot Online Data Collection for SMA PT Instructions.docx Instructions IC Document
SMA-PT-SSA.docx SSA IC Document
SMA-PT-SSB.docx SSB IC Document

Information Collection (IC) Details

IC Title:	Spinal Muscular Atrophy (SMA) Proficiency Testing (PT) Pilot	Agency IC Tracking Number:	0920-0879-21AJ

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Data Reporting Page	Attachment A - Pilot Online Data Collection for SMA PT Screenshot of Data Reporting Page.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	none	Feedback Form	Attachment B - Pilot Online Data Collection for SMA PT Feedback Form.xlsm		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 80	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	80	80
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Research Determination	Attachment C - Pilot Online Data Collection for SMA PT Research Determination.pdf	11/09/2020
Email invitation	Attachment D - Pilot Online Data Collection for SMA PT Email Invitation.docx	11/09/2020
Email packet	Attachment E - Pilot Online Data Collection for SMA PT Email Packet.docx	11/09/2020
Email reminder	Attachment F - Pilot Online Data Collection for SMA PT Email Reminder.pdf	11/09/2020
Instructions	Attachment G - Pilot Online Data Collection for SMA PT Instructions.docx	11/09/2020
SSA	SMA-PT-SSA.docx	11/09/2020
SSB	SMA-PT-SSB.docx	11/09/2020

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