Information Collection

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

IC 244433 under ICR 201711-0920-012 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.