Information Collection

ALS Registry Research Application

IC 222085 under ICR 201809-0923-001 · OMB 0923-0041.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0041 can be found here:

Documents and Forms

Document Name Document Type
ALS Registry Research Application Form
Registry Research Application Attach_11A-ALS Registry Research Application Form clean 20161103.docx Form
ALS Registry Research Application Attach_11A-ALS Registry Research Application Form clean 20161103.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	ALS Registry Research Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	none	Registry Research Application	Attach_11A-ALS Registry Research Application Form clean 20161103.docx		Yes	Yes	Fillable Fileable
Form	none	ALS Registry Research Application	Attach_11A-ALS Registry Research Application Form clean 20161103.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Records of Persons Exposed or Potentially Exposed to Toxic or Hazardous Substances, 09-19-0001	FR Citation: 76 FR 4432

Number of Respondents: 36	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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