Nuclear Test Personnel Review Forms

Forms and Documents

Document Name	Status
Form DTRA Form 150 Nuclear Test Personnel Review Forms Form	Modified
0704-0447_SSA_1.13.2020.docx Supporting Statement A	2021-01-13
0704-0447_PIA_12.3.2019.pdf Supplementary Document	2021-01-05
SSN_JustificationMemo_NTPR_Signed_12.4.2019.pdf Supplementary Document	2021-01-05
2019 HDTRA 010 Preamble SORN.docx Supplementary Document	2020-10-07

IC Document Collections

IC ID	Document Title	Status
181351	Nuclear Test Personnel Review Forms Form	Modified

ICR Details

OMB Control No: 0704-0447	ICR Reference No: 202010-0704-001
Status: Received in OIRA	Previous ICR Reference No: 201710-0704-005
Agency/Subagency: DOD/DODDEP	Agency Tracking No:
Title: Nuclear Test Personnel Review Forms
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 01/15/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2021
Responses	278	86
Time Burden (Hours)	113	71
Cost Burden (Dollars)	2,717	1,574

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Abstract: DTRA collects this information to provide verification of participation and/or radiation dose assessment for atomic veterans seeking radiogenic disease compensation from the VA (Veterans Affairs) or DOJ (Department of Justice).

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Authorizing Statute(s): US Code: 38 USC 1112 Name of Law: Veteran's Benefits
   US Code: 38 USC 1154 Name of Law: Veteran's Benefits
   US Code: 42 USC 2210 Name of Law: Radiation Exposure Compensation Act
   PL: Pub.L. 98 - 542 xxx Name of Law: The Veterans' Dioxin and Radiation Exposure Compensation Standards Act
   PL: Pub.L. 115 - 232 581 Name of Law: John S. McCain National Defense Authorization Act for Fiscal Year 2019
  

Citations for New Statutory Requirements: PL: Pub.L. 115 - 232 581 Name of Law: John S. McCain National Defense Authorization Act for Fiscal Year 2019

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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:
	85 FR 66312	10/19/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 2653	01/13/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Nuclear Test Personnel Review Forms	DTRA Form 150, DTRA Form 150-A, DTRA Form 150 B, DTRA Form 150 D	Nuclear Test Personnel Review Information Request and Release ,   Questionnaire for Continental United States Test Participants ,   Questionnaire for Oceanic Test Participants ,   Atomic Veterans Service Certificate Application and Nuclear Test Personnel Review Information Request and Release

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ICR Summary of Burden

	Total Request	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	278	86	0	192	0	0
Annual Time Burden (Hours)	113	71	0	42	0	0
Annual Cost Burden (Dollars)	2,717	1,574	0	1,143	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: Burden increase due to the addition of the Atomic Veterans Service Certificate Application authorized by the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (PL 115-232, Sec 581).

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Annual Cost to Federal Government: $26,595

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

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Common Form ICR:  No

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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: 01/15/2021

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