ALS Registry Research Application

[ATSDR] National Amyotrophic Lateral Sclerosis (ALS) Registry

Documents and Forms

Document Name Document Type
ALS Registry Research Application Form and Instruction
ALS Registry Research Application Form and Instruction
National Amyotrophic Lateral Sclerosis (ALS) Registry Re P_AppM1 ALS Research Application.docx Form and Instruction
National Amyotrophic Lateral Sclerosis (ALS) Registry Re P_AppM1 ALS Research Application.docx Form and Instruction

Information Collection (IC) Details

IC Title:	ALS Registry Research Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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)	P_AppM1 ALS Research Application.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 %

	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

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.