Countermeasures Injury Compensation Program (CICP)

ICR 201111-0915-005

OMB: 0915-0334

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Justification for No Material/Nonsubstantive Change
2011-11-22
Supplementary Document
2011-11-22
IC Document Collections
ICR Details
0915-0334 201111-0915-005
Historical Active 201111-0915-001
HHS/HSA
Countermeasures Injury Compensation Program (CICP)
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 11/28/2011
Retrieve Notice of Action (NOA) 11/23/2011
  Inventory as of this Action Requested Previously Approved
09/30/2013 09/30/2013 09/30/2013
2,520 0 2,520
12,600 0 12,600
0 0 0

The Health Resources and Services Administration (HRSA) is requesting approval for the information collection reqirements contained in the the Countermeasures Injury Compensation Program. The Countermeasures Injury Compensation Program is designed to provide compensation to individuals for serious physical injuries or deaths from pandemic, epidemic, or security countermeasures identified in declarations issued by the Secretary pursuant to section 319F-3(b) of the Public Health Service Act.

PL: Pub.L. 109 - 148 319F3,4 Name of Law: Public Readiness and Emergency Preparedness Act
  
None

0906-AA83 Final or interim final rulemaking 76 FR 62306 10/07/2011

No

1
IC Title Form No. Form Name
Countermeasures Injury Compensation Program Request Package 2, 1 Health Information Authorization Form ,   CICP Request for Benefits Form

  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 2,520 2,520 0 0 0 0
Annual Time Burden (Hours) 12,600 12,600 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$43,458
No
No
No
No
No
Uncollected
Carla Haddad 301 443-0165 Carla.Haddad@hrsa.hhs.gov

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
11/23/2011


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