Maritime Illness Database and Reporting System (MIDRS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-1260 Recordkeeping of Engineering and Sanitation Records	Form and Instruction	New	Available
Form 0920-1260 Recordkeeping of Engineering and Sanitation Records	Form and Instruction	New	Available
Form 0920-1260 72-hour Food/Activity History Template (AGE cases)	Form and Instruction	New	Available
Form 0920-1260 (Passenger) 72-hour Food/Activity History Template (AGE cases)	Form and Instruction	New	Repair queued
Form 0920-1260 Last Symptom Check and Return to Work Clearance (food and nonfood employees)	Form and Instruction	New	Available
Form 0920-1260 Last Symptom Check and Return to Work Clearance (food and nonfood employees)	Form and Instruction	New	Repair queued
Form 0920-1260 Interviews to Determine AGE Status (initial, 24-hr, 48-hr)(asymptomatic cabin mates and immediate contacts of symptomatic crew)	Form and Instruction	New	Available
Form 0920-1260 Interviews to Determine AGE Status (initial, 24-hr, 48-hr)(asymptomatic cabin mates and immediate contacts of symptomatic crew)	Form and Instruction	New	Repair queued
Form 0920-1260 Three-day Pre-embarkation AGE Illness Assessment (all crew members)	Form and Instruction	New	Available
Form 0920-1260 Three-day Pre-embarkation AGE Illness Assessment (all crew members)	Form and Instruction	New	Repair queued
Form 0920-1260 72-hour Food/Activity History Template (AGE cases)	Form and Instruction	New	Available
Form 0920-1260 (CREW) 72-hour Food/Activity History Template (AGE cases)	Form and Instruction	New	Repair queued
Form 0920-1260 Recordkeeping of AGE Surveillance Records	Form and Instruction	New	Available
Form 0920-1260 Recordkeeping of AGE Surveillance Records	Form and Instruction	New	Repair queued
Form 0920-1260 Daily Reports of AGE Logs	Form and Instruction	New	Available
Form 0920-1260 Daily Reports of AGE Logs	Form and Instruction	New	Repair queued
Form 092-1260 Special Reports exceeding 2%-3% AGE Threshold (web/phone/email/fax)	Form and Instruction	New	Available
Form 092-1260 Special Reports exceeding 2%-3% AGE Threshold (web/phone/email/fax)	Form and Instruction	New	Repair queued
Form 0920-1260 Att5a2 4 hr AGEIllnssRprt (phone email fax) 20220125	Form and Instruction	New	Available
Form 0920-1260 AGE Illness Report 4 hours before arrival (phone/email/fax)	Form and Instruction	New	Repair queued
Form 0920-1260 AGE Illness Report 4 hours before arrival (web)	Form and Instruction	New	Available
Form 0920-1260 AGE Illness Report 4 hours before arrival (web)	Form and Instruction	New	Available
Form 0920-1260 AGE Illness Report 24 hours before arrival (phone/email/fax)	Form and Instruction	New	Available
Form 0920-1260 AGE Illness Report 24 hours before arrival (phone/email/fax)	Form and Instruction	New	Repair queued
Form 0920-1260 AGE Illness Report 24 hours before arrival (web)	Form and Instruction	New	Available
Form 0920-1260 AGE Illness Report 24 hours before arrival (web)	Form and Instruction	New	Repair queued
72-hr Food/Activity History Template	Form and Instruction	Removed	Available
71.21 (c) 72-hour food/activity history - AGE Passenger and Crew cases	Form and Instruction	Removed	Repair queued
Gastrointestinal Illness Surveillance System Questionnaire	Form and Instruction	Removed	Available
71.21 (c) Recordkeeping - medical records (72-hour food/activity history)	Form and Instruction	Removed	Available
Documentation of Last Symptom and Clearance to Return to Work	Form and Instruction	Removed	Available
71.21 (c) Recordkeeping – medical records (Documentation of date/time of last symptom and clearance to return to work for food and nonfood employees)	Form and Instruction	Removed	Repair queued
Documentation of Last Symptom and Clearance to Return to Work	Form and Instruction	Removed	Available
71.21 (c) Documentation of date/time of last symptom and clearance to return to work for food and nonfood employees	Form and Instruction	Removed	Repair queued
Documentation of 3-day pre-embarkation AGE illness assessment	Form and Instruction	Removed	Available
71.21(c) Recordkeeping - medical records (Documentation of 3-day pre-embarkation AGE illness assessment for all crew members)	Form and Instruction	Removed	Repair queued
Documentation of 3-day pre-embarkation AGE illness assessment	Form and Instruction	Removed	Available
71.21 (c) Documentation of 3-day pre-embarkation AGE illness assessment for all crew members	Form and Instruction	Removed	Repair queued
Documentation of Interviews with AGE Crew Case Cabin Mates and Immediate Contacts to Determine AGE Illness Status	Form and Instruction	Removed	Available
71.21 (c) Recordkeeping – medical records (Interviews with AGE crew case cabin mates and immediate contacts to determine AGE illness status and documentation of interview dates/times)	Form and Instruction	Removed	Repair queued
Documentation of Interviews with AGE Crew Case Cabin Mates and Immediate Contacts to Determine AGE Illness Status	Form and Instruction	Removed	Available
71.21 (c) Interviews with AGE crew case cabin mates and immediate contacts to determine AGE illness status and documentation of interview dates/times	Form and Instruction	Removed	Available
VSP AGE Log	Form and Instruction	Removed	Available
71.21 (c) Recordkeeping – medical records (AGE Logs)	Form and Instruction	Removed	Repair queued
VSP AGE Log	Form and Instruction	Removed	Repair queued
71.21 (c) AGE Logs	Form and Instruction	Removed	Repair queued
Recordkeeping - MIDRS Template	Form and Instruction	Removed	Available
71.21(c) Recordkeeping - Gastrointestinal Illnesses Report 24 and 4 hours before arrival	Form and Instruction	Removed	Repair queued
MIDRS Template - screenshot	Form and Instruction	Removed	Available
Gastrointestinal Illness (GI) Template	Form and Instruction	Removed	Available
71.21(c) Gastrointestinal Illness Report - 24 and 4 hours before arrival (MIDRS)	Form and Instruction	Removed	Available
Att8 IntlConventionofSafetyofLifeatSea.pdf	Supplementary Document	Uploaded 2022-04-04	Available
Att7 ResearchDeterminationForm 20210916.pdf	Supplementary Document	Uploaded 2022-04-04	Repair queued
1 - VSP MIDRS Revision List Attachments 20220125.docx	Supplementary Document	Uploaded 2022-04-04	Repair queued
Att4b.VSP2018OperationsManual.pdf	Supplementary Document	Uploaded 2022-04-04	Repair queued
Att4a.42CFR71.1bii.pdf	Supplementary Document	Uploaded 2022-04-04	Repair queued
Att3b. 1987FRN_VSPfromDGMQtoNCEH.pdf	Supplementary Document	Uploaded 2022-04-04	Repair queued
Att3a.1985FRN_VSPinDGMQ.pdf	Supplementary Document	Uploaded 2022-04-04	Repair queued
Att2. MIDRS_60D_FRN.pdf	Supplementary Document	Uploaded 2022-04-04	Repair queued
Att1c. 42CFRPart71 -- Foreign Quarantine.pdf	Supplementary Document	Uploaded 2022-04-04	Repair queued
Att1b.42USCSection269.pdf	Supplementary Document	Uploaded 2022-04-04	Repair queued
Att1a. 42USCSection264.pdf	Supplementary Document	Uploaded 2022-04-04	Repair queued
0 - Privacy Act Checklist MIDRS Rev 20220125.docx	Supplementary Document	Uploaded 2022-04-04	Repair queued
Att10.PIA.pdf	Supplementary Document	Uploaded 2019-02-21	Repair queued
Att9.IntlConventionofSafetyofLifeatSea.pdf	Supplementary Document	Uploaded 2019-02-21	Available
Att6.ResearchDeterminationForm.pdf	Supplementary Document	Uploaded 2019-02-21	Available
Att4b.VSP2018OperationsManual.pdf	Supplementary Document	Uploaded 2019-02-21	Repair queued
Att3b. 1987FRN_VSPfromDGMQtoNCEH.pdf	Supplementary Document	Uploaded 2019-02-20	Repair queued
Att3a.1985FRN_VSPinDGMQ.pdf	Supplementary Document	Uploaded 2019-02-20	Repair queued
Att2.60dayFRN.pdf	Supplementary Document	Uploaded 2019-02-20	Repair queued
Att1c. 42CFRPart71.pdf	Supplementary Document	Uploaded 2019-02-20	Repair queued
Att1b.42USCSection269.pdf	Supplementary Document	Uploaded 2019-02-20	Repair queued
Att1a. 42USCSection264.pdf	Supplementary Document	Uploaded 2019-02-20	Repair queued
1 - SSB_MIDRS Revision 20220125.docx	Supporting Statement B	Uploaded 2022-04-04	Repair queued
1 - SSA_MIDRS Revision 202200404 v2.docx	Supporting Statement A	Uploaded 2022-04-04	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
252608	Recordkeeping of Engineering and Sanitation Records	Form and Instruction	New	Recordkeeping of Engineering and Sanitation Records
252608	Recordkeeping of Engineering and Sanitation Records	Form and Instruction	New
252607	(Passenger) 72-hour Food/Activity History Template (AGE cases)	Form and Instruction	New	72-hour Food/Activity History Template (AGE cases)
252607	(Passenger) 72-hour Food/Activity History Template (AGE cases)	Form and Instruction	New
252606	Last Symptom Check and Return to Work Clearance (food and nonfood employees)	Form and Instruction	New	Last Symptom Check and Return to Work Clearance (food and nonfood employees)
252606	Last Symptom Check and Return to Work Clearance (food and nonfood employees)	Form and Instruction	New
252605	Interviews to Determine AGE Status (initial, 24-hr, 48-hr)(asymptomatic cabin mates and immediate contacts of symptomatic crew)	Form and Instruction	New	Interviews to Determine AGE Status (initial, 24-hr, 48-hr)(asymptomatic cabin mates and immediate contacts of symptomatic crew)
252605	Interviews to Determine AGE Status (initial, 24-hr, 48-hr)(asymptomatic cabin mates and immediate contacts of symptomatic crew)	Form and Instruction	New
252603	Three-day Pre-embarkation AGE Illness Assessment (all crew members)	Form and Instruction	New	Three-day Pre-embarkation AGE Illness Assessment (all crew members)
252603	Three-day Pre-embarkation AGE Illness Assessment (all crew members)	Form and Instruction	New
252602	(CREW) 72-hour Food/Activity History Template (AGE cases)	Form and Instruction	New	72-hour Food/Activity History Template (AGE cases)
252602	(CREW) 72-hour Food/Activity History Template (AGE cases)	Form and Instruction	New
252599	Recordkeeping of AGE Surveillance Records	Form and Instruction	New	Recordkeeping of AGE Surveillance Records
252599	Recordkeeping of AGE Surveillance Records	Form and Instruction	New
252598	Daily Reports of AGE Logs	Form and Instruction	New	Daily Reports of AGE Logs
252598	Daily Reports of AGE Logs	Form and Instruction	New
252597	Special Reports exceeding 2%-3% AGE Threshold (web/phone/email/fax)	Form and Instruction	New	Special Reports exceeding 2%-3% AGE Threshold (web/phone/email/fax)
252597	Special Reports exceeding 2%-3% AGE Threshold (web/phone/email/fax)	Form and Instruction	New
252596	AGE Illness Report 4 hours before arrival (phone/email/fax)	Form and Instruction	New	Att5a2 4 hr AGEIllnssRprt (phone email fax) 20220125
252596	AGE Illness Report 4 hours before arrival (phone/email/fax)	Form and Instruction	New
252595	AGE Illness Report 4 hours before arrival (web)	Form and Instruction	New	AGE Illness Report 4 hours before arrival (web)
252595	AGE Illness Report 4 hours before arrival (web)	Form and Instruction	New
252594	AGE Illness Report 24 hours before arrival (phone/email/fax)	Form and Instruction	New	AGE Illness Report 24 hours before arrival (phone/email/fax)
252594	AGE Illness Report 24 hours before arrival (phone/email/fax)	Form and Instruction	New
252593	AGE Illness Report 24 hours before arrival (web)	Form and Instruction	New	AGE Illness Report 24 hours before arrival (web)
252593	AGE Illness Report 24 hours before arrival (web)	Form and Instruction	New
235080	71.21 (c) 72-hour food/activity history - AGE Passenger and Crew cases	Form and Instruction	Removed	72-hr Food/Activity History Template
235080	71.21 (c) 72-hour food/activity history - AGE Passenger and Crew cases	Form and Instruction	Removed
235079	71.21 (c) Recordkeeping - medical records (72-hour food/activity history)	Form and Instruction	Removed	Gastrointestinal Illness Surveillance System Questionnaire
235079	71.21 (c) Recordkeeping - medical records (72-hour food/activity history)	Form and Instruction	Removed
235078	71.21 (c) Recordkeeping – medical records (Documentation of date/time of last symptom and clearance to return to work for food and nonfood employees)	Form and Instruction	Removed	Documentation of Last Symptom and Clearance to Return to Work
235078	71.21 (c) Recordkeeping – medical records (Documentation of date/time of last symptom and clearance to return to work for food and nonfood employees)	Form and Instruction	Removed
235077	71.21 (c) Documentation of date/time of last symptom and clearance to return to work for food and nonfood employees	Form and Instruction	Removed	Documentation of Last Symptom and Clearance to Return to Work
235077	71.21 (c) Documentation of date/time of last symptom and clearance to return to work for food and nonfood employees	Form and Instruction	Removed
235076	71.21(c) Recordkeeping - medical records (Documentation of 3-day pre-embarkation AGE illness assessment for all crew members)	Form and Instruction	Removed	Documentation of 3-day pre-embarkation AGE illness assessment
235076	71.21(c) Recordkeeping - medical records (Documentation of 3-day pre-embarkation AGE illness assessment for all crew members)	Form and Instruction	Removed
235075	71.21 (c) Documentation of 3-day pre-embarkation AGE illness assessment for all crew members	Form and Instruction	Removed	Documentation of 3-day pre-embarkation AGE illness assessment
235075	71.21 (c) Documentation of 3-day pre-embarkation AGE illness assessment for all crew members	Form and Instruction	Removed
235074	71.21 (c) Recordkeeping – medical records (Interviews with AGE crew case cabin mates and immediate contacts to determine AGE illness status and documentation of interview dates/times)	Form and Instruction	Removed	Documentation of Interviews with AGE Crew Case Cabin Mates and Immediate Contacts to Determine AGE Illness Status
235074	71.21 (c) Recordkeeping – medical records (Interviews with AGE crew case cabin mates and immediate contacts to determine AGE illness status and documentation of interview dates/times)	Form and Instruction	Removed
235073	71.21 (c) Interviews with AGE crew case cabin mates and immediate contacts to determine AGE illness status and documentation of interview dates/times	Form and Instruction	Removed	Documentation of Interviews with AGE Crew Case Cabin Mates and Immediate Contacts to Determine AGE Illness Status
235073	71.21 (c) Interviews with AGE crew case cabin mates and immediate contacts to determine AGE illness status and documentation of interview dates/times	Form and Instruction	Removed
235072	71.21 (c) Recordkeeping – medical records (AGE Logs)	Form and Instruction	Removed	VSP AGE Log
235072	71.21 (c) Recordkeeping – medical records (AGE Logs)	Form and Instruction	Removed
235071	71.21 (c) AGE Logs	Form and Instruction	Removed	VSP AGE Log
235071	71.21 (c) AGE Logs	Form and Instruction	Removed
235070	71.21(c) Recordkeeping - Gastrointestinal Illnesses Report 24 and 4 hours before arrival	Form and Instruction	Removed	Recordkeeping - MIDRS Template
235070	71.21(c) Recordkeeping - Gastrointestinal Illnesses Report 24 and 4 hours before arrival	Form and Instruction	Removed
235047	71.21(c) Gastrointestinal Illness Report - 24 and 4 hours before arrival (MIDRS)	Form and Instruction	Removed	MIDRS Template - screenshot
235047	71.21(c) Gastrointestinal Illness Report - 24 and 4 hours before arrival (MIDRS)	Form and Instruction	Removed	Gastrointestinal Illness (GI) Template
235047	71.21(c) Gastrointestinal Illness Report - 24 and 4 hours before arrival (MIDRS)	Form and Instruction	Removed

ICR Details

OMB Control No: 0920-1260	ICR Reference No: 202204-0920-002
Status: Historical Active	Previous ICR Reference No: 201812-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1260
Title: Maritime Illness Database and Reporting System (MIDRS)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/17/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/05/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2026	36 Months From Approved	03/31/2023
Responses	10,109,580	0	13,750
Time Burden (Hours)	5,782,228	0	1,538
Cost Burden (Dollars)	0	0	0

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Abstract: The CDC’s Vessel Sanitation Program (VSP) is requesting a 3-year Paperwork Reduction Act (PRA) clearance for this revision information collection request (ICR). In the past three years, the VSP has received 13,352 AGE reports to through its “Maritime Illness Database and Reporting System (MIDRS)” (OMB Control No. 0920-1260; expiration date 04/30/2022). Since the first quarter of 2020, the COVID-19 pandemic disrupted the number of cruise ship voyages operating to U.S. ports of call. Between March 2020 and October 2021, cruise industry operations were suspended under a federally issued No Sail Order, and then subsequently under a Conditional Sailing Order to prevent the risk of introducing, transmitting, and spreading COVID-19 by cruise ship travelers. As a result, the number of AGE reports submitted to MIDRS in 2020 and 2021 was substantially lower (n=2,667 and n=1,717, respectively), compared to 2019 (n=8,968). The information collected by the VSP is designed to align with and support the collaboration between the cruise ship industry and government to define and reduce health risks associated with vessels and to ensure a healthful and clean environment for vessels’ passengers and crew.

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Authorizing Statute(s): US Code: 42 USC 264 Name of Law: U.S. PHSA
   US Code: 42 USC 269 Name of Law: U.S. PHSA
  

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:
	86 FR 58915	10/25/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 19095	04/01/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 13

table that charts list of burden

IC Title	Form No.	Form Name
(CREW) 72-hour Food/Activity History Template (AGE cases)	0920-1260	72-hour Food/Activity History Template (AGE cases)
(Passenger) 72-hour Food/Activity History Template (AGE cases)	0920-1260	72-hour Food/Activity History Template (AGE cases)
71.21 (c) 72-hour food/activity history - AGE Passenger and Crew cases	NA	72-hr Food/Activity History Template
71.21 (c) AGE Logs	NA	VSP AGE Log
71.21 (c) Documentation of 3-day pre-embarkation AGE illness assessment for all crew members	NA	Documentation of 3-day pre-embarkation AGE illness assessment
71.21 (c) Documentation of date/time of last symptom and clearance to return to work for food and nonfood employees	NA	Documentation of Last Symptom and Clearance to Return to Work
71.21 (c) Interviews with AGE crew case cabin mates and immediate contacts to determine AGE illness status and documentation of interview dates/times	NA	Documentation of Interviews with AGE Crew Case Cabin Mates and Immediate Contacts to Determine AGE Illness Status
71.21 (c) Recordkeeping - medical records (72-hour food/activity history)	NA	Gastrointestinal Illness Surveillance System Questionnaire
71.21 (c) Recordkeeping – medical records (AGE Logs)	NA	VSP AGE Log
71.21 (c) Recordkeeping – medical records (Documentation of date/time of last symptom and clearance to return to work for food and nonfood employees)	NA	Documentation of Last Symptom and Clearance to Return to Work
71.21 (c) Recordkeeping – medical records (Interviews with AGE crew case cabin mates and immediate contacts to determine AGE illness status and documentation of interview dates/times)	NA	Documentation of Interviews with AGE Crew Case Cabin Mates and Immediate Contacts to Determine AGE Illness Status
71.21(c) Gastrointestinal Illness Report - 24 and 4 hours before arrival (MIDRS)	NA, NA	Gastrointestinal Illness (GI) Template ,   MIDRS Template - screenshot
71.21(c) Recordkeeping - Gastrointestinal Illnesses Report 24 and 4 hours before arrival	NA	Recordkeeping - MIDRS Template
71.21(c) Recordkeeping - medical records (Documentation of 3-day pre-embarkation AGE illness assessment for all crew members)	NA	Documentation of 3-day pre-embarkation AGE illness assessment
AGE Illness Report 24 hours before arrival (phone/email/fax)	0920-1260	AGE Illness Report 24 hours before arrival (phone/email/fax)
AGE Illness Report 24 hours before arrival (web)	0920-1260	AGE Illness Report 24 hours before arrival (web)
AGE Illness Report 4 hours before arrival (phone/email/fax)	0920-1260	Att5a2 4 hr AGEIllnssRprt (phone email fax) 20220125
AGE Illness Report 4 hours before arrival (web)	0920-1260	AGE Illness Report 4 hours before arrival (web)
Daily Reports of AGE Logs	0920-1260	Daily Reports of AGE Logs
Interviews to Determine AGE Status (initial, 24-hr, 48-hr)(asymptomatic cabin mates and immediate contacts of symptomatic crew)	0920-1260	Interviews to Determine AGE Status (initial, 24-hr, 48-hr)(asymptomatic cabin mates and immediate contacts of symptomatic crew)
Last Symptom Check and Return to Work Clearance (food and nonfood employees)	0920-1260	Last Symptom Check and Return to Work Clearance (food and nonfood employees)
Recordkeeping of AGE Surveillance Records	0920-1260	Recordkeeping of AGE Surveillance Records
Recordkeeping of Engineering and Sanitation Records	0920-1260	Recordkeeping of Engineering and Sanitation Records
Special Reports exceeding 2%-3% AGE Threshold (web/phone/email/fax)	092-1260	Special Reports exceeding 2%-3% AGE Threshold (web/phone/email/fax)
Three-day Pre-embarkation AGE Illness Assessment (all crew members)	0920-1260	Three-day Pre-embarkation AGE Illness Assessment (all crew members)

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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	10,109,580	13,750	0	10,081,830	14,000	0
Annual Time Burden (Hours)	5,782,228	1,538	0	5,778,244	2,446	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The overarching goal of this ICR is to improve AGE illness reporting by the cruise industry while also improving the reporting systems in order to achieve a measurable health impact.CDC has revised its burden estimates for an increase of 10,103,030 annual responses (n=10,116,780) compared to that approved in 2019 (n=13,750). CDC also estimates the total annualized time burden is 5,782,228 hours, which is an increase of 5,780,690 hours compared to the previously approved 1,538 hours.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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.     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? Yes

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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: 04/05/2022

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