Information Collection

ALS Registry Research Application

IC 222085 under ICR 202105-0923-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
ALS Registry Research Application	Form and Instruction
National Amyotrophic Lateral Sclerosis (ALS) Registry Re Attach_11A-ALS Registry Research Application Form.docx	Form and Instruction
National Amyotrophic Lateral Sclerosis (ALS) Registry Re Attach_11A-ALS Registry Research Application Form.docx	Form and Instruction

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:

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	n/a	National Amyotrophic Lateral Sclerosis (ALS) Registry Research Application Form (rev. May 2021)	Attach_11A-ALS Registry Research Application Form.docx		Yes	Yes	Fillable Fileable

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 %

table that charts list of burden
	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

table that charts IC Documents
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.