[ATSDR] National Amyotrophic Lateral Sclerosis (ALS) Registry

ICR 202301-0923-001

OMB: 0923-0041

Federal Form Document

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0923-0041 can be found here:

2024-08-05 - No material or nonsubstantive change to a currently approved collection

Forms and Documents

Document Name	Status
Follow-up Questions - ALS-associated and Clinical Factors Form and Instruction	New
Follow-up Questions - Environmental Factors Form and Instruction	New
Follow-up Questions - Lifestyle Information Form and Instruction	New
Follow-up Questions - Demography Form and Instruction	New
ALS Biorepository Collection Form- Saliva Form	Modified
National Office Outreach Reporting Form	Modified
Outreach Reporting Form for Chapters and Districts Form	Modified
Annual Update for Projects Receiving Specimens or Data Form	Modified
ALS Registry Research Application Form and Instruction	Modified
ALS Biorepository Specimen Processing Form	Modified
ALS DIsease Progression Survey Form	Modified
Essential Questionnaire Form and Instruction	Modified
ALS Case Registration Form	Modified
ALS Validation Questions Form	Modified
P_AppS.B-6b COVID-19 Biorepostiory InfoSht_042821.docx Supplementary Document	2023-01-17
P_AppS.B-6a COVID-19 Restart Plan 04282021.docx Supplementary Document	2023-01-17
P_AppF Privacy Statement.docx Supplementary Document	2023-01-17
P_AppE7 NCHS Comments Surveys.docx Supplementary Document	2023-01-17
P_AppE - Survey Introduction_final.docx Supplementary Document	2023-01-17
P_AppD4 Biorepository Saliva Consent.docx Supplementary Document	2023-01-17
P_AppD3 Biorepository Postmortem Consent.docx Supplementary Document	2023-01-17
P_AppD2 Biorepository Consent.docx Supplementary Document	2023-01-17
P_AppD1 ALS Registry Consent Form.jpeg Supplementary Document	2023-01-17
0 - List of Attach and Append.docx Supplementary Document	2023-01-17
Att9 Prevalence Rate State 4yr avg.xlsx Supplementary Document	2023-01-12
Att8 Survey Burden Calculation.docx Supplementary Document	2023-01-12
Att7 Biorepository Pilot Study Report.pdf Supplementary Document	2023-01-12
Att5 Privacy Impact Assessment 2020.pdf Supplementary Document	2023-01-12
Att4 IRB Approval Memo.docx Supplementary Document	2023-01-12
Att3 Summary of Changes.docx Supplementary Document	2023-01-12
Att2 60-day FRN.pdf Supplementary Document	2023-01-12
Att1 Public Law 110-373.docx Supplementary Document	2023-01-12
0- SSB National ALS Registry.docx Supporting Statement B	2023-01-12
0- SSA National ALS Registry_final.docx Supporting Statement A	2023-01-12

IC Document Collections

IC ID	Document Title	Status
257949	Follow-up Questions - ALS-associated and Clinical Factors Form and Instruction	New
257948	Follow-up Questions - Environmental Factors Form and Instruction	New
257947	Follow-up Questions - Lifestyle Information Form and Instruction	New
257946	Follow-up Questions - Demography Form and Instruction	New
224351	ALS Biorepository Collection Form- Saliva Form	Modified
222089	National Office Outreach Reporting Form	Modified
222088	Outreach Reporting Form for Chapters and Districts Form	Modified
222087	Annual Update for Projects Receiving Specimens or Data Form	Modified
222085	ALS Registry Research Application Form and Instruction	Modified
222083	ALS Biorepository Specimen Processing Form	Modified
192032	ALS DIsease Progression Survey Form	Modified
192031	Essential Questionnaire Form and Instruction	Modified
192030	ALS Case Registration Form	Modified
192029	ALS Validation Questions Form	Modified

ICR Details