NPS Institutional Animal Care and Use Committee (IACUC) General Submission, Exhibitor, Annual Review, and Amendment Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-1303 IACUC Concurrence Form	Form	Modified	Available
Form 10-1303 IACUC Concurrence Form	Form	Modified	Available
Form 10-1304 IACUC Field Study Form	Form	Modified	Available
Form 10-1304 IACUC Field Study Form	Form	Modified	Available
Form 10-1302 IACUC Annual Review Form	Form	Modified	Available
Form 10-1302 IACUC Annual Review Form	Form	Modified	Repair queued
Form 10-1301A IACUC Amendment Form	Form	Modified	Available
Form 10-1301A IACUC Amendment Form	Form	Modified	Available
Form 10-1301 IACUC General Submission Form	Form	Modified	Available
Form 10-1301 IACUC General Submission Form	Form	Modified	Available
1025-0265 - Published 30 Day Notice - 84 FR 44633.pdf	Supplementary Document	Uploaded 2019-08-26	Available
STATUTE-80-Pg350.pdf	Supplementary Document	Uploaded 2019-07-10	Available
1024-0265 60-Day FRN.pdf	Supplementary Document	Uploaded 2019-07-10	Available
IACUC Supporting_Statement_A 7-17-2019.docx	Supporting Statement A	Uploaded 2019-07-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
220710	IACUC Concurrence Form (private)	Form	Modified	IACUC Concurrence Form
220709	IACUC Concurrence Form (state and local)	Form	Modified	IACUC Concurrence Form
220708	IACUC Field Study Form (private)	Form	Modified	IACUC Field Study Form
220707	IACUC Field Study Form (State and Local)	Form	Modified	IACUC Field Study Form
205460	IACUC Annual Review Form (private)	Form	Modified	IACUC Annual Review Form
205459	IACUC Annual Review Form (state and local)	Form	Modified	IACUC Annual Review Form
205458	IACUC Amendment Form (private)	Form	Modified	IACUC Amendment Form
205456	IACUC Amendment Form (state and local)	Form	Modified	IACUC Amendment Form
205407	IACUC General Submission Form (private)	Form	Modified	IACUC General Submission Form
205405	IACUC General Submission Form (state and local)	Form	Modified	IACUC General Submission Form

ICR Details

OMB Control No: 1024-0265	ICR Reference No: 201907-1024-001
Status: Historical Active	Previous ICR Reference No: 201509-1024-003
Agency/Subagency: DOI/NPS	Agency Tracking No:
Title: NPS Institutional Animal Care and Use Committee (IACUC) General Submission, Exhibitor, Annual Review, and Amendment Forms
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/29/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/26/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2023	36 Months From Approved	06/30/2020
Responses	230	0	230
Time Burden (Hours)	140	0	140
Cost Burden (Dollars)	0	0	0

---

Abstract: The National Park Service (NPS) is requesting a renewal of this collection. Pursuant to the Animal Welfare Act (AWA), Animal Welfare Act Regulations (AWAR), and the Interagency Research Animal Committee (IRAC), any entity or institution that uses vertebrate animals for research, teaching, or training purposes must have an oversight committee to evaluate all aspects of that institution's animal care and use. All research, teaching, and training projects involving the use and care of vertebrate animals taking place on NPS territories must be reviewed and approved by the NPS IACUC prior to starting. Principal Investigators (PI) are required to submit one of the following forms for consideration by the committee: • The NPS IACUC General Submission (GS) form • The NPS IACUC Field Study form • The NPS IACUC Concurrence Review form • The NPS IACUC Amendment form • The NPS IACUC Annual Review form

---

Authorizing Statute(s): US Code: 7 USC 2131-2159 Name of Law: Animal Welfare Act
   US Code: 16 USC a-1 Name of Law: NPS Organic Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 21355	05/14/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 44633	08/26/2019
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
IACUC Amendment Form (private)	10-1301A	IACUC Amendment Form
IACUC Amendment Form (state and local)	10-1301A	IACUC Amendment Form
IACUC Annual Review Form (private)	10-1302	IACUC Annual Review Form
IACUC Annual Review Form (state and local)	10-1302	IACUC Annual Review Form
IACUC Concurrence Form (private)	10-1303	IACUC Concurrence Form
IACUC Concurrence Form (state and local)	10-1303	IACUC Concurrence Form
IACUC Field Study Form (State and Local)	10-1304	IACUC Field Study Form
IACUC Field Study Form (private)	10-1304	IACUC Field Study Form
IACUC General Submission Form (private)	10-1301	IACUC General Submission Form
IACUC General Submission Form (state and local)	10-1301	IACUC General Submission Form

---

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	230	230	0	0	0	0
Annual Time Burden (Hours)	140	140	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $244,160

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.     Yes

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.     Yes

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? No

---

Common Form ICR:  No

---

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: 08/26/2019

---