Nuclear Test Personnel Review Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form DTRA Form 150 D Atomic Veterans Service Certificate Application and Nuclear Test Personnel Review Information Request and Release	Form	Modified	Available
Form DTRA Form 150 B Questionnaire for Oceanic Test Participants	Form	Modified	Available
Form DTRA Form 150-A Questionnaire for Continental United States Test Participants	Form	Modified	Available
Form DTRA Form 150 Nuclear Test Personnel Review Information Request and Release	Form	Modified	Available
Form DTRA Form 150 Nuclear Test Personnel Review Forms	Form	Modified	Repair queued
0704-0447_SSA_2.28.2024.docx	Supporting Statement A	Uploaded 2024-02-28	Repair queued
0704-0447_PIA_12.3.2019.pdf	Supplementary Document	Uploaded 2021-01-05	Repair queued
SSN_JustificationMemo_NTPR_Signed_12.4.2019.pdf	Supplementary Document	Uploaded 2021-01-05	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
181351	Nuclear Test Personnel Review Forms	Form	Modified	Atomic Veterans Service Certificate Application and Nuclear Test Personnel Review Information Request and Release
181351	Nuclear Test Personnel Review Forms	Form	Modified	Questionnaire for Oceanic Test Participants
181351	Nuclear Test Personnel Review Forms	Form	Modified	Questionnaire for Continental United States Test Participants
181351	Nuclear Test Personnel Review Forms	Form	Modified	Nuclear Test Personnel Review Information Request and Release
181351	Nuclear Test Personnel Review Forms	Form	Modified

ICR Details

OMB Control No: 0704-0447	ICR Reference No: 202402-0704-012
Status: Active	Previous ICR Reference No: 202010-0704-001
Agency/Subagency: DOW/DODDEP	Agency Tracking No:
Title: Nuclear Test Personnel Review 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: 04/03/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/29/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2027	36 Months From Approved	04/30/2024
Responses	278	0	278
Time Burden (Hours)	113	0	113
Cost Burden (Dollars)	3,466	0	2,717

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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): 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
   US Code: 38 USC 1154 Name of Law: Veteran's Benefits
   US Code: 42 USC 2210 Name of Law: Radiation Exposure Compensation Act
   US Code: 38 USC 1112 Name of Law: Veteran's Benefits
  

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:
	88 FR 88380	12/21/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 14461	02/27/2024
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

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

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	278	278	0	0	0	0
Annual Time Burden (Hours)	113	113	0	0	0	0
Annual Cost Burden (Dollars)	3,466	2,717	0	749	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:

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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: 02/29/2024

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