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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:
0920-0929
ICR Reference No:
201406-0920-015
Status:
Historical Active
Previous ICR Reference No:
201201-0920-011
Agency/Subagency:
HHS/CDC
Agency Tracking No:
0920-092914AGW
Title:
World Trade Center Health Program Petition for the Addition of a New WTC-Related Health Condition for Coverage under the World Trade Center (WTC) Health Program
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
07/07/2014
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/26/2014
Terms of Clearance:
Previous terms of clearance apply.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2015
04/30/2015
04/30/2015
Responses
100
0
100
Time Burden (Hours)
4,000
0
4,000
Cost Burden (Dollars)
0
0
0
Abstract:
This submission is to account for non-substantive changes to 0920-0929 (World Trade Center Health Program Petition for the Addition of a New WTC-Related Health Condition for Coverage under the World Trade Center Health Program, expiration 4/30/2015). The James Zadroga 9/11 Health and Compensation Act of 2010 (the Act) established the World Trade Center (WTC) Health Program. The law requires the WTC Health Program to provide monitoring and treatment benefits to responders and survivors who are determined to be eligible for the Program. The Act included a list of WTC-related health conditions (42 CFR ยง 88.1) which are covered for treatment by the Program. The Act also allows any interested party to petition the WTC Program Administrator to add a condition to the list. The Program has created a form that has been approved by OMB (0920-0929) to help an individual(s) provide the necessary information to request the Program Administrator to add a condition.
Authorizing Statute(s):
PL:
Pub.L. 111 - 347 3312
Name of Law: James Zadroga 9/11 Health and Compensation Act of 2010
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0920-AA45
Final or interim final rulemaking
76 FR 38938
07/01/2011
Federal Register Notices & Comments
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Petition for the Addition of a New WTC-Related Health Condition for Coverage under the World Trade Center (WTC) Health Program
1
Petition for the Addition of health conditions
Petition for the Addition of a New WTC-Related Health Condition for Coverage under the World Trade Center (WTC) Health Program
1
Petition for the Addition of a New WTC-Related Health Condition for Coverage under the World Trade Center (WTC) Health Program
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
100
100
0
0
0
0
Annual Time Burden (Hours)
4,000
4,000
0
0
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:
Yes
Burden Reduction Due to:
Changing Forms
Short Statement:
The revised form improves clarity for the petitioner and to accurately reflect the current list of covered conditions. The following changes will be made: In the first sentence of the General Instructions section, the current petition refers people to page 5 for a full list of covered conditions. Since that list has changed over time we are going to remove that sentence and page 5 of the listed conditions and refer people to the website for the full and current list of covered conditions. This will prevent any future changes to the petition form as the current list is always updated on the website. The language was modified in section C1 to make it clearer what information needs to be provided by the petitioner in support of the petition. Minor grammatical changes have been made to throughout the form for clarity. No additional burden will be added to the respondents as this collection is already accounted for in the current OMB package (0920-0929). The respondent does not complete any additional paperwork as the edits are minor changes to current language on the applications.
Annual Cost to Federal Government:
$34,480
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
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?
Uncollected
Agency Contact:
Catina Conner 4046394775
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:
06/26/2014
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