DERT Extramural Grantee Data Collection (NIEHS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 NIEHS simplified data collection form	Form	New	Available
Form 1 DERT Extramural Grantee Data Collection Survey	Form	Unchanged	Available
Attachment A 2018-2021 NIEHS DERT Grantee Survey.docx	Supplementary Document	Uploaded 2018-12-20	Available
NIEHS DERT Change Request Memo Dec 2018.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2018-12-20	Available
30-day common form2018-22038.pdf	Supplementary Document	Uploaded 2018-10-11	Available
FINAL NIEHS DEGDC commonform support_stmt_a 2018 (6).docx	Supporting Statement A	Uploaded 2018-10-09	Available
Attachment C NIEHS DEGDC Table Shells.docx	Supplementary Document	Uploaded 2018-10-03	Available
Attachment B PIA for NIEHS DERT Extramural Granttee Data Collection DEGDC (Feb 2012).pdf	Supplementary Document	Uploaded 2018-10-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
234598	NIEHS simplified data collection form	Form	New
233400	DERT Extramural Grantee Data Collection Survey	Form	Unchanged

ICR Details

OMB Control No: 0925-0757	ICR Reference No: 201812-0925-002
Status: Active	Previous ICR Reference No: 201810-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: DERT Extramural Grantee Data Collection (NIEHS)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/08/2019
	Date Received in OIRA: 12/21/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2021	11/30/2021	11/30/2021
Responses	1,640	0	1,400
Time Burden (Hours)	740	0	700
Cost Burden (Dollars)	0	0	0

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Abstract: The National Institute of Environmental Health Sciences (NIEHS) is requesting the Extramural Grantee Data Collection Survey be converted to a “Common Form” to include EPA.

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Authorizing Statute(s): US Code: 42 USC 285 Name of Law: Public Health Service 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:
	83 FR 19073	05/01/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 51470	10/11/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
NIEHS simplified data collection form	1	NIEHS Simplified Form
DERT Extramural Grantee Data Collection Survey	1	NIEHS DERT Grantee Survey

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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	1,640	1,400	0	240	0	0
Annual Time Burden (Hours)	740	700	0	40	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The burden increase is only due to the additional respondent group.

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Annual Cost to Federal Government: $20,638

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:  Yes

Description/Changes for Common Form Usage: 

Approved RCFs using this ICR

table that charts list of RCF

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title
EPA/OEI	201906-2025-001CF	DERT Extramural Grantee Data Collection Survey	Active	DERT Extramural Grantee Data Collection Survey

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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: 12/21/2018

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