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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0920-1001
ICR Reference No:
201311-0920-009
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
HHS/CDC
Agency Tracking No:
20876
Title:
World Trade Center Enrollment & Appeals - Pentagon & Shanksville
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
12/13/2013
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/14/2013
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2016
36 Months From Approved
Responses
2,685
0
0
Time Burden (Hours)
831
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
Title XXXIII of the Public Health Safety Act establishes the World Trade Center (WTC) Health Program within the Department of Health and Human Services. This program provides medical monitoring and treatment benefits to responders to the September 11, 2001 terrorist attacks in New York City, at the Pentagon, and in Shanksville, PA, and to survivors of the terriorist attacks in New York City.
Authorizing Statute(s):
US Code:
33 USC 3311
Name of Law: Zadroga Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0920-AA48
Final or interim final rulemaking
78 FR 18855
03/28/2013
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
78 FR 54471
09/04/2013
30-day Notice:
Federal Register Citation:
Citation Date:
78 FR 67148
11/08/2013
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
6
IC Title
Form No.
Form Name
Pharmacies Outpatient Prescription Pharmaceuticals
Responder Appeals Certification of Health Conditions
Responder Appeals Treatment
Responder Appeals to Eligibility Denial
Responder Eligibility Application
none
Eligibility Application
Responder Travel Refund Request
none
Travel Refund Request
ICR Summary 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
2,685
0
0
2,685
0
0
Annual Time Burden (Hours)
831
0
0
831
0
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:
No
Burden Reduction Due to:
Short Statement:
This is a new data collection request.
Annual Cost to Federal Government:
$64,425
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
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?
Uncollected
Agency Contact:
Carol Marsh 404 639-4773 cww6@cdc.gov
Common Form ICR:
No
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:
11/14/2013
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