Department of Health and Human Services
Food and Drug Administration
OMB NO: 0910-0001 EXPIRATION DATE: 05/31/2008
RESPS:42,878 HOURS:2,372,556 COSTS(000):$0
FDA Approval to Market a New Drug
FORMS: FDA-2252 FDA-2253 FDA-3331
OMB NO: 0910-0014 EXPIRATION DATE: 05/31/2009
RESPS:1,277,517 HOURS:71,369,525 COSTS(000):$0
Investigational New Drug Regulations
FORMS: 1571 1572
OMB NO: 0910-0016 EXPIRATION DATE: 11/30/2006
RESPS:13 HOURS:31,385 COSTS(000):$560
Submission of Petitions: Food Additive, Color Additive
(Including Labeling), and Generally Recognized as Safe
Affirmation; and Electronic Submission Using FDA Forms 3503 and
3504
FORMS: FDA-3503 FDA-3504
OMB NO: 0910-0021 EXPIRATION DATE: 11/30/2006
RESPS:62 HOURS:211 COSTS(000):$0
Interstate Shellfish Dealer's Certificate
FORMS: FDA-3038
OMB NO: 0910-0025 EXPIRATION DATE: 12/31/2006
RESPS:47,343 HOURS:324,957 COSTS(000):$0
Reporting and Recordkeeping for Electronic Products - General
Requirements
FORMS: FDA-2579 2767 2877 3147
OMB NO: 0910-0027 EXPIRATION DATE: 11/30/2007
RESPS:15 HOURS:6 COSTS(000):$0
Voluntary Registration of Cosmetics Product Establishment
FORMS: FDA-2511
OMB NO: 0910-0030 EXPIRATION DATE: 12/31/2008
RESPS:1,503 HOURS:742 COSTS(000):$0
Cosmetic Product Voluntary Reporting Program - 21 CFR Part 720
FORMS: 2512 2512A 2514
OMB NO: 0910-0032 EXPIRATION DATE: 12/31/2007
RESPS:1,406 HOURS:340,858 COSTS(000):$0
New Animal Drug Application, 21 CFR Part 514
FORMS: 356V
OMB NO: 0910-0037 EXPIRATION DATE: 06/30/2008
RESPS:17,586 HOURS:1,985,108 COSTS(000):$0
Food Canning Establishment Registration, Process Filing and
Recordkeeping for Acidified and Thermally Processed Low-Acid
Foods
FORMS: 2541 2541A 2541C
OMB NO: 0910-0045 EXPIRATION DATE: 12/31/2007
RESPS:75,687 HOURS:189,217 COSTS(000):$0
Registration of Producers of Drugs and Listing of Drugs in
Commercial Distribution
FORMS: NONE
OMB NO: 0910-0046 EXPIRATION DATE: 05/31/2009
RESPS:3,709,134 HOURS:519,279 COSTS(000):$0
Electronic Importer's Entry Notice
FORMS: NONE
OMB NO: 0910-0052 EXPIRATION DATE: 03/31/2009
RESPS:2,875 HOURS:1,533 COSTS(000):$0
Blood Establishment Registration and Product Lising Form FDA 2830
FORMS: FDA-2830
OMB NO: 0910-0053 EXPIRATION DATE: 02/29/2008
RESPS:340 HOURS:2,142 COSTS(000):$0
Radioactive Drug Research Committee (RDRC) Report on Research
Use of Radioactive Drug Study Summary
FORMS: FDA-2914 FDA-2915
OMB NO: 0910-0073 EXPIRATION DATE: 09/30/2007
RESPS:8,254 HOURS:2,833,020 COSTS(000):$1,182
Current Good Manufacturing Practice (CGMP); Quality System (QS)
Regulation
FORMS: NONE
OMB NO: 0910-0078 EXPIRATION DATE: 11/30/2006
RESPS:4,527 HOURS:61,021 COSTS(000):$0
Investigational Device Exemptions Reports and Records - 21 CFR
812
FORMS: NONE
OMB NO: 0910-0114 EXPIRATION DATE: 11/30/2006
RESPS:26 HOURS:461 COSTS(000):$0
Administrative Detention and Banned Medical Devices
FORMS: NONE
OMB NO: 0910-0116 EXPIRATION DATE: 12/31/2008
RESPS:530,829 HOURS:564,678 COSTS(000):$0
Current Good Manufacturing Practices for Blood and Related
Regulations for and Blood Components
FORMS: NONE
OMB NO: 0910-0117 EXPIRATION DATE: 06/30/2008
RESPS:4,527 HOURS:34,622 COSTS(000):$0
New Animal Drugs for Investigational Use
FORMS: 3458
OMB NO: 0910-0119 EXPIRATION DATE: 04/30/2008
RESPS:36,150 HOURS:1,311,157 COSTS(000):$0
Good Laboratory Practice (GLP) Regulations for Nonclinical
Laboratory Studies - 21 CFR Part 58
FORMS: NONE
OMB NO: 0910-0120 EXPIRATION DATE: 05/31/2007
RESPS:26,100 HOURS:359,000 COSTS(000):$0
Premarket Notification Submission 5100(k), Subpart E
FORMS: 3514
OMB NO: 0910-0130 EXPIRATION DATE: 11/30/2007
RESPS:73,000 HOURS:7,300,000 COSTS(000):$0
Protection of Human Subjects; Recordkeeping Requirements for
Institutional Review Boards (IRBs)
FORMS: NONE
OMB NO: 0910-0131 EXPIRATION DATE: 11/30/2006
RESPS:1,800 HOURS:8,100 COSTS(000):$0
Agreement for Shipments of Devices for Sterilization
FORMS: NONE
OMB NO: 0910-0133 EXPIRATION DATE: 07/31/2008
RESPS:14 HOURS:166 COSTS(000):$0
Temporary Marketing Permit Applications
FORMS: NONE
OMB NO: 0910-0138 EXPIRATION DATE: 03/31/2009
RESPS:6 HOURS:3,000 COSTS(000):$0
Reclassification Petitions for Medical Devices
FORMS: FDA-3427 FDA-3428 FDA-3429
OMB NO: 0910-0139 EXPIRATION DATE: 09/30/2008
RESPS:1,174,427 HOURS:798,132 COSTS(000):$0
Current Good Manufacturing Practice; Proposed Amendment of
Certain Requirements for Finished Pharmaceuticals
FORMS: NONE
OMB NO: 0910-0152 EXPIRATION DATE: 12/31/2007
RESPS:36,444,150 HOURS:7,315,661 COSTS(000):$0
Current Good Manufacturing Practice Regulations for Medicated
Feed, 21 CFR Part 225
FORMS: NONE
OMB NO: 0910-0154 EXPIRATION DATE: 12/31/2007
RESPS:180,550 HOURS:157,550 COSTS(000):$0
Good Manufacturing Practice Regulations for Type A Medicated
Articles, 21 CFR Part 226
FORMS: NONE
OMB NO: 0910-0167 EXPIRATION DATE: 07/31/2007
RESPS:1 HOURS:37,343 COSTS(000):$0
Orphan Drug Products
FORMS: NONE
OMB NO: 0910-0183 EXPIRATION DATE: 04/30/2009
RESPS:516 HOURS:6,108 COSTS(000):$0
General Administrative Procedures: Citizen Petitions; Petition
for Reconsideration or Stay of Action; Advisory Opinions
FORMS: NONE
OMB NO: 0910-0184 EXPIRATION DATE: 05/31/2009
RESPS:10 HOURS:200 COSTS(000):$0
Filing Objections and Requests for a Hearing on a Regulation or
Order
FORMS: NONE
OMB NO: 0910-0186 EXPIRATION DATE: 06/30/2009
RESPS:720 HOURS:720 COSTS(000):$0
Irradiation in the Production, Processing and Handling of Food
FORMS: NONE
OMB NO: 0910-0188 EXPIRATION DATE: 07/31/2008
RESPS:1 HOURS:12,854 COSTS(000):$0
Infant Formula Recall Regulations
FORMS: NONE
OMB NO: 0910-0191 EXPIRATION DATE: 05/31/2009
RESPS:1 HOURS:792 COSTS(000):$0
Notice of Participation - 21 CFR 12.45
FORMS: NONE
OMB NO: 0910-0206 EXPIRATION DATE: 08/31/2006
RESPS:6,747 HOURS:20,588 COSTS(000):$0
Request for Samples and Protocols
FORMS: NONE
OMB NO: 0910-0212 EXPIRATION DATE: 12/31/2008
RESPS:1,626 HOURS:2,425 COSTS(000):$0
Regulations Under the Federal Import Milk Act (21 CFR Part 1210)
(formerly Federal Import Milk Act)
FORMS: 1815 1993 1994 1995 1996 1997
OMB NO: 0910-0216 EXPIRATION DATE: 11/30/2007
RESPS:4,603 HOURS:2,302 COSTS(000):$0
Color Additive Requests and Recordkeeping
FORMS: NONE
OMB NO: 0910-0230 EXPIRATION DATE: 04/30/2009
RESPS:410,645 HOURS:7,037,246 COSTS(000):$1,416
Adverse Drug Experience Reporting
FORMS: NONE
OMB NO: 0910-0231 EXPIRATION DATE: 09/30/2007
RESPS:581 HOURS:113,464 COSTS(000):$0
Premarket Approval of Medical Devices - 21 CFR Part 814
FORMS: NONE
OMB NO: 0910-0233 EXPIRATION DATE: 11/30/2007
RESPS:9 HOURS:800 COSTS(000):$0
Patent Term Restoration
FORMS: NONE
OMB NO: 0910-0249 EXPIRATION DATE: 10/31/2008
RESPS:16,625 HOURS:201,875 COSTS(000):$0
FDA Recall Regulations
FORMS: NONE
OMB NO: 0910-0256 EXPIRATION DATE: 03/31/2007
RESPS:40 HOURS:25,968 COSTS(000):$0
Infant Formula Requirements
FORMS: NONE
OMB NO: 0910-0264 EXPIRATION DATE: 11/30/2006
RESPS:20 HOURS:50 COSTS(000):$0
Export of Medical Devices - Foreign Letters of Approval
FORMS: NONE
OMB NO: 0910-0275 EXPIRATION DATE: 11/30/2008
RESPS:1 HOURS:10 COSTS(000):$0
State Enforcement Notification (21 CFR 100.2(d))
FORMS: NONE
OMB NO: 0910-0277 EXPIRATION DATE: 06/30/2008
RESPS:1 HOURS:40 COSTS(000):$0
State Petitions for Exemption from Preemption
FORMS: NONE
OMB NO: 0910-0284 EXPIRATION DATE: 09/30/2006
RESPS:45,528 HOURS:138,114 COSTS(000):$0
Records and Reports Concerning Experience with Approved New
Animal Drugs
FORMS: 1932 1932A 2301
OMB NO: 0910-0291 EXPIRATION DATE: 10/31/2008
RESPS:488,403 HOURS:523,118 COSTS(000):$0
MedWatch: The FDA Medical Products Reporting Program
FORMS: FDA-3500 3500A
OMB NO: 0910-0297 EXPIRATION DATE: 12/31/2006
RESPS:3,231 HOURS:969 COSTS(000):$0
User Fee Cover Sheet
FORMS: 3397
OMB NO: 0910-0298 EXPIRATION DATE: 03/31/2007
RESPS:6 HOURS:288 COSTS(000):$0
Food Additives; Threshold of Regulation for Substances Used in
Food-Contact Articles
FORMS: NONE
OMB NO: 0910-0302 EXPIRATION DATE: 05/31/2007
RESPS:62 HOURS:592,166 COSTS(000):$0
Human Tissue Intended for Transplantation
FORMS: NONE
OMB NO: 0910-0303 EXPIRATION DATE: 07/31/2008
RESPS:4,500 HOURS:270,000 COSTS(000):$0
Electronic Records: Electronic Signatures
FORMS: NONE
OMB NO: 0910-0308 EXPIRATION DATE: 07/31/2008
RESPS:22,324 HOURS:493,522 COSTS(000):$0
Adverse Experience Reporting for Licensed Biological Product;
and General Records
FORMS: NONE
OMB NO: 0910-0309 EXPIRATION DATE: 03/31/2007
RESPS:36,000,000 HOURS:3,219,936 COSTS(000):$19,491
Mammography Facilities, Standards, and Lay Summaries for Patients
FORMS: FDA-3422
OMB NO: 0910-0320 EXPIRATION DATE: 09/30/2007
RESPS:191 HOURS:553 COSTS(000):$0
Request for Information from U.S. Processors that Export to the
European Community
FORMS: NONE
OMB NO: 0910-0322 EXPIRATION DATE: 12/31/2006
RESPS:10,748 HOURS:210,182 COSTS(000):$0
21 CFR 25-Enviornmental Impact Considerations
FORMS: NONE
OMB NO: 0910-0325 EXPIRATION DATE: 11/30/2008
RESPS:2 HOURS:8,320 COSTS(000):$0
Extralabel Drug Use in Animals
FORMS: NONE
OMB NO: 0910-0330 EXPIRATION DATE: 07/31/2008
RESPS:71 HOURS:1,420 COSTS(000):$0
Premarket Notification for a New Dietary Ingredient
FORMS: NONE
OMB NO: 0910-0331 EXPIRATION DATE: 12/31/2006
RESPS:2,500 HOURS:1,875 COSTS(000):$0
Food Labeling: Notification Procedures for Statements on Dietary
Supplements
FORMS: NONE
OMB NO: 0910-0332 EXPIRATION DATE: 12/31/2008
RESPS:108 HOURS:10,038 COSTS(000):$0
Medical Devices; Humanitarian Use Devices; 21 CFR Part 814 -
Subpart H
FORMS: NONE
OMB NO: 0910-0337 EXPIRATION DATE: 12/31/2006
RESPS:1,292 HOURS:71 COSTS(000):$0
Medicated Fee Mill License Application
FORMS: 3448
OMB NO: 0910-0338 EXPIRATION DATE: 09/30/2008
RESPS:14,613 HOURS:335,088 COSTS(000):$0
General Licensing Provisions: Biologics License Application,
Changes to an Approved Application, Labeling, Revocation and
Suspension, and Forms FDA 356h & 2567
FORMS: FDA-2567 FDA-356H
OMB NO: 0910-0339 EXPIRATION DATE: 05/31/2007
RESPS:400 HOURS:5,600 COSTS(000):$0
Substances Prohibited from Use in Animal Food or Feed; Animal
Proteins Prohibited in Ruminant Feed
FORMS: NONE
OMB NO: 0910-0340 EXPIRATION DATE: 06/30/2008
RESPS:39,932 HOURS:120,578 COSTS(000):$0
Over-the-Counter Human Drugs; Labeling Requirements
FORMS: NONE
OMB NO: 0910-0341 EXPIRATION DATE: 10/31/2006
RESPS:924 HOURS:157 COSTS(000):$0
FDA Safety Alert/Public Health Advisory Readership Survey
FORMS: NONE
OMB NO: 0910-0342 EXPIRATION DATE: 05/31/2009
RESPS:60 HOURS:9,900 COSTS(000):$0
Substances Generally Recognized as Safe: Notification Procedure
FORMS: NONE
OMB NO: 0910-0345 EXPIRATION DATE: 09/30/2008
RESPS:1 HOURS:1,401 COSTS(000):$0
2005 Food Safety Survey
FORMS: NONE
OMB NO: 0910-0354 EXPIRATION DATE: 12/31/2006
RESPS:5,850 HOURS:627,075 COSTS(000):$9,406
Procedures for the Safe Processing and Importing of Fish and
Fishery Products; 21 CFR Part 123
FORMS: NONE
OMB NO: 0910-0356 EXPIRATION DATE: 03/31/2007
RESPS:860 HOURS:544,036 COSTS(000):$0
Substantial Evidence of Effectiveness of New Animal Drugs
FORMS: NONE
OMB NO: 0910-0359 EXPIRATION DATE: 04/30/2008
RESPS:625 HOURS:6,250 COSTS(000):$0
Medical Devices; Reports of Corrections and Removals
FORMS: NONE
OMB NO: 0910-0360 EXPIRATION DATE: 05/31/2008
RESPS:6,000 HOURS:1,800 COSTS(000):$0
Customer/Partner Service Surveys - (Extension)
FORMS: NONE
OMB NO: 0910-0363 EXPIRATION DATE: 11/30/2008
RESPS:1,880,521 HOURS:120,184 COSTS(000):$0
Veterinary Feed Directive
FORMS: NONE
OMB NO: 0910-0370 EXPIRATION DATE: 09/30/2007
RESPS:557 HOURS:1,762 COSTS(000):$0
Specific Requirements on the Content and Format of Labeling for
Human Prescription Drugs; Addition of Geriatric Use Subsection
FORMS: NONE
OMB NO: 0910-0374 EXPIRATION DATE: 09/30/2008
RESPS:3 HOURS:1,153 COSTS(000):$0
Guidance for Industry: Notification of a Health Claim or
Nutrient Content Claim Based on an Authoritative Statement of a
Scientific Body
FORMS: NONE
OMB NO: 0910-0375 EXPIRATION DATE: 12/31/2007
RESPS:11 HOURS:10,860 COSTS(000):$0
Medical Devices; Third Party Review Under FDAMA
FORMS: NONE
OMB NO: 0910-0378 EXPIRATION DATE: 04/30/2008
RESPS:210 HOURS:14,622 COSTS(000):$0
Medical Devices, Third Party Premarket Submission Review and
Quality System Inspections Under U.S./E.C. MRA
FORMS: NONE
OMB NO: 0910-0381 EXPIRATION DATE: 05/31/2007
RESPS:509,579 HOURS:1,594,269 COSTS(000):$16,800
Food Labeling Regulations
FORMS: NONE
OMB NO: 0910-0387 EXPIRATION DATE: 04/30/2008
RESPS:1 HOURS:41,850 COSTS(000):$0
Medical Devices Registration and Listing
FORMS: 2891 2891A 2892
OMB NO: 0910-0389 EXPIRATION DATE: 08/31/2008
RESPS:114 HOURS:8,720 COSTS(000):$0
Guidance for Industry: Fast Track Drug Development Programs -
Designation, Development, and Application Review
FORMS: NONE
OMB NO: 0910-0390 EXPIRATION DATE: 12/31/2008
RESPS:157 HOURS:2,114 COSTS(000):$0
Dissemination of Information on Unapproval/New Uses for Marketed
Drugs, Biologics, and Devices
FORMS: NONE
OMB NO: 0910-0393 EXPIRATION DATE: 08/31/2008
RESPS:1,100,000 HOURS:4,248 COSTS(000):$0
Prescription Drug Product Labeling; Medication Guide Requirements
FORMS: NONE
OMB NO: 0910-0396 EXPIRATION DATE: 04/30/2009
RESPS:1 HOURS:18,750 COSTS(000):$0
Financial Disclosure by Clinical Investigators
FORMS: 3454 3455
OMB NO: 0910-0409 EXPIRATION DATE: 10/31/2008
RESPS:2 HOURS:4,000 COSTS(000):$0
Regs. for In Vivo Radiopharmaceuticals Used for Diagnosis nd
Monitoring - Final Rule
FORMS: NONE
OMB NO: 0910-0428 EXPIRATION DATE: 01/31/2009
RESPS:25 HOURS:25 COSTS(000):$0
Record Retention Requirements for the Soy Protein/CHD Health
Claim
FORMS: NONE
OMB NO: 0910-0429 EXPIRATION DATE: 03/31/2009
RESPS:3,642 HOURS:49,004 COSTS(000):$0
Guidance for Industry on Formal Meetings with Sponsors and
Applicants for PDUFA Products
FORMS: 1571 1572 356H
OMB NO: 0910-0430 EXPIRATION DATE: 04/30/2009
RESPS:11 HOURS:88 COSTS(000):$0
Guidance for Industry on Formal Dispute Resolutions; Appeals
Above the Division Level
FORMS: 1571 356H
OMB NO: 0910-0432 EXPIRATION DATE: 02/28/2009
RESPS:2 HOURS:1,082 COSTS(000):$0
Medical Device Recall Authority
FORMS: NONE
OMB NO: 0910-0433 EXPIRATION DATE: 03/31/2007
RESPS:65 HOURS:1,560 COSTS(000):$0
Postmarketing Studies for Human Drugs and Licensed Biological
Products; Status Report
FORMS: NONE
OMB NO: 0910-0435 EXPIRATION DATE: 08/31/2006
RESPS:102,261,312 HOURS:10,634,432 COSTS(000):$0
Prescription Drug Marketing Act of 1987; Policies, Requirements,
and Administrative Procedures
FORMS: NONE
OMB NO: 0910-0437 EXPIRATION DATE: 05/31/2009
RESPS:122,325 HOURS:138,271 COSTS(000):$0
Medical Devices; Medical Device Reporting; Manufacturer
reporting; importer reporting, user facility reporting,
distributor reporting
FORMS: FDA-3417 FDA-3419
OMB NO: 0910-0439 EXPIRATION DATE: 07/31/2009
RESPS:10 HOURS:140 COSTS(000):$0
Aluminum in Large and Small Volume Parenterals Used in Total
Parenteral Nutrition
FORMS: NONE
OMB NO: 0910-0442 EXPIRATION DATE: 04/30/2008
RESPS:1,481,939 HOURS:3,407,184 COSTS(000):$0
Medical Devices; Device Tracking (Amended)
FORMS: NONE
OMB NO: 0910-0445 EXPIRATION DATE: 12/31/2006
RESPS:164 HOURS:46,576 COSTS(000):$0
Guidance for Industry: Submitting and Reviewing Complete
Responses to Clinical Holds
FORMS: NONE
OMB NO: 0910-0448 EXPIRATION DATE: 01/31/2007
RESPS:600 HOURS:600 COSTS(000):$0
Adoption of FDA Food Code by Local, State and Tribal Governments
FORMS: NONE
OMB NO: 0910-0449 EXPIRATION DATE: 12/31/2006
RESPS:138 HOURS:5,778 COSTS(000):$0
Postmarket Surveillance of Medical Devices
FORMS: NONE
OMB NO: 0910-0450 EXPIRATION DATE: 02/28/2007
RESPS:84 HOURS:33 COSTS(000):$0
Guidance for Industry on How to Use E-Mail to Submit a Notice of
Intent to Slaughter for Human Food Purposes
FORMS: FDA-3488
OMB NO: 0910-0452 EXPIRATION DATE: 03/31/2007
RESPS:168 HOURS:116 COSTS(000):$0
Guidance for Indusry on How to Use E-Mail to Submit a Request
for a Meeting or Teleconference to the Office of New Animal Drug
Evaluation
FORMS: 3489
OMB NO: 0910-0453 EXPIRATION DATE: 02/28/2007
RESPS:324 HOURS:262 COSTS(000):$0
Guidance for Industry on How to Use E-Mail to Submit a Notice of
Final Disposition of Animals Not Intended for Immediate Slaughter
FORMS: FDA-3487
OMB NO: 0910-0454 EXPIRATION DATE: 03/31/2007
RESPS:140 HOURS:70 COSTS(000):$0
Guidance for Industry on How to Use E-Mail Submit Information to
the Center for Veterinary Medicine
FORMS: 3538
OMB NO: 0910-0456 EXPIRATION DATE: 12/31/2006
RESPS:50 HOURS:156 COSTS(000):$0
Infectious Disease Issues in Xenotransplantation
FORMS: NONE
OMB NO: 0910-0458 EXPIRATION DATE: 03/31/2007
RESPS:33,922 HOURS:67,844 COSTS(000):$0
Biological Products: Reporting of Biological Product Deviations
in Manufacturing
FORMS: 3486
OMB NO: 0910-0459 EXPIRATION DATE: 05/31/2007
RESPS:38,514 HOURS:177,165 COSTS(000):$0
Information Program on Clinical Trials for Serious and
Life-Threatening Diseases: Maintaining a Databank
FORMS: NONE
OMB NO: 0910-0466 EXPIRATION DATE: 07/31/2007
RESPS:15,035 HOURS:360,930 COSTS(000):$0
Hazard Analysis and Critical Control Point (HACCP) Procedures
for the Safe and Sanitary Processing of Juice (21 CFR Part 120)
FORMS: NONE
OMB NO: 0910-0469 EXPIRATION DATE: 07/31/2007
RESPS:1,370 HOURS:1,005 COSTS(000):$0
Human Cells, Tissues, and Cellular and Tissue-Based Products;
Establishment Registration and Listing
FORMS: FDA-3356
OMB NO: 0910-0470 EXPIRATION DATE: 09/30/2007
RESPS:334 HOURS:4,723 COSTS(000):$0
Special Protocol Assessment Guidance
FORMS: NONE
OMB NO: 0910-0471 EXPIRATION DATE: 09/30/2007
RESPS:2,800 HOURS:2,772 COSTS(000):$0
Adverse Event Pilot Program for Medical Devices
FORMS: NONE
OMB NO: 0910-0482 EXPIRATION DATE: 06/30/2008
RESPS:2,065 HOURS:43,214 COSTS(000):$0
Exports: Notification and Recordkeeping Requirements
FORMS: NONE
OMB NO: 0910-0485 EXPIRATION DATE: 06/30/2008
RESPS:2,320,385 HOURS:3,503,120 COSTS(000):$0
Medical Device Labeling Regulations
FORMS: NONE
OMB NO: 0910-0491 EXPIRATION DATE: 05/31/2009
RESPS:195 HOURS:98 COSTS(000):$0
Emergency Shortages Data Collection System (formerly Emergency
Medical Device Shortage Program Survey)
FORMS: NONE
OMB NO: 0910-0495 EXPIRATION DATE: 12/31/2008
RESPS:126 HOURS:15,985 COSTS(000):$23,500
Food Additives; Food Contact Substances Notification System
FORMS: 3479 3480
OMB NO: 0910-0497 EXPIRATION DATE: 11/30/2007
RESPS:2,574 HOURS:4,252 COSTS(000):$0
Focus Groups as Used by the Food and Drug Administration
FORMS: NONE
OMB NO: 0910-0498 EXPIRATION DATE: 03/31/2009
RESPS:14,213 HOURS:21,170 COSTS(000):$0
Export Certificates for FDA Regulated Products under U.S.C.
Sections 801(e) and 802
FORMS: 3613 3613A 3613B 3613C 3613D 3613E
OMB NO: 0910-0500 EXPIRATION DATE: 11/30/2007
RESPS:6,000 HOURS:3,000 COSTS(000):$0
Generic FDA Rapid Response Surveys
FORMS: NONE
OMB NO: 0910-0502 EXPIRATION DATE: 10/31/2006
RESPS:421,361 HOURS:521,831 COSTS(000):$0
Registration of Food Facilities Under the Public Health Security
and Bioterrorism Preparedness and Response Act of 2002
FORMS: FDA-3537 FDA-3537A
OMB NO: 0910-0508 EXPIRATION DATE: 12/31/2006
RESPS:3,000 HOURS:3,000 COSTS(000):$0
FY 2003 MDUFMA Small Business Qualification Certification (Form
FDA 3602)
FORMS: 3602
OMB NO: 0910-0509 EXPIRATION DATE: 12/31/2006
RESPS:50 HOURS:150 COSTS(000):$0
Establishing a List of U.S. Dairy Producers for Export to Chile
FORMS: NONE
OMB NO: 0910-0510 EXPIRATION DATE: 11/30/2006
RESPS:25 HOURS:2,550 COSTS(000):$0
Medical Devices; Inspection by Accredited Persons Program Under
the Medical Device User Fee and Modernization Act of 2002
(MDUFMA)
FORMS: NONE
OMB NO: 0910-0511 EXPIRATION DATE: 11/30/2006
RESPS:5,000 HOURS:1,500 COSTS(000):$0
Medical Device User Fee Cover Sheet - FDA Form 3601
FORMS: FDA-3601
OMB NO: 0910-0513 EXPIRATION DATE: 10/31/2006
RESPS:481 HOURS:499,805 COSTS(000):$0
Applications for FDA Approval to Market a New Drug: Patient
Listing Requirements and Application of 30-month Stays on
Approval of Abbreviated New Drug Applications Certifying That...
FORMS: 3542 3542(A)
OMB NO: 0910-0515 EXPIRATION DATE: 11/30/2006
RESPS:307,600 HOURS:615,200 COSTS(000):$171,700
Food Labeling: Trans Fatty Acids in Nutrition Labeling
FORMS: NONE
OMB NO: 0910-0516 EXPIRATION DATE: 10/31/2006
RESPS:5,000 HOURS:1,500 COSTS(000):$0
Impact of Risk Management Programs on the Practice of Pharmacy -
Survey
FORMS: NONE
OMB NO: 0910-0518 EXPIRATION DATE: 06/30/2007
RESPS:125 HOURS:10,000 COSTS(000):$0
Guidance for Industry: Continuous Marketing Applications: Pilot
2 Scientific Feedback and Interactions During Development of
Fast Track Products Under PDUFA
FORMS: NONE
OMB NO: 0910-0519 EXPIRATION DATE: 09/30/2007
RESPS:120 HOURS:480 COSTS(000):$0
Control of Communicable Diseases; Requests for Exemptions from
the Restrictions on African Rodents, Prairie Dogs, and Certain
Other Animals
FORMS: NONE
OMB NO: 0910-0520 EXPIRATION DATE: 10/31/2006
RESPS:6,891,625 HOURS:2,836,781 COSTS(000):$6,268
Prior Notice of Imported Food Shipments
FORMS: 3540
OMB NO: 0910-0521 EXPIRATION DATE: 01/31/2007
RESPS:5 HOURS:70,550 COSTS(000):$0
Assessment of the Effects of Antimicrobial Drug Residues from
Food of Animal Origin on the Human Intestinal Flora
FORMS: NONE
OMB NO: 0910-0523 EXPIRATION DATE: 02/28/2007
RESPS:28 HOURS:672 COSTS(000):$0
Product Jurisdiction: Assignment of Agency Component for Review
of Premarket Applications
FORMS: NONE
OMB NO: 0910-0524 EXPIRATION DATE: 02/28/2007
RESPS:100 HOURS:20 COSTS(000):$0
Draft Guidance for Industry: How to Use E-Mail to Submit a Study
Protocol
FORMS: 3536
OMB NO: 0910-0528 EXPIRATION DATE: 03/31/2007
RESPS:1,158 HOURS:579 COSTS(000):$0
Guidance for Industry - Reports on the Status of Postmarketing
Studies - Implementation of Section 130 of the Food and Drug
Administration Modernization Act of 1997
FORMS: NONE
OMB NO: 0910-0530 EXPIRATION DATE: 11/30/2006
RESPS:9,200 HOURS:52,344 COSTS(000):$0
Requirements for Submission of Labeling for Human Prescription
Drugs and Biologics in Electronic Format
FORMS: NONE
OMB NO: 0910-0537 EXPIRATION DATE: 02/28/2007
RESPS:41,753,827 HOURS:1,777,550 COSTS(000):$0
Bar Code Label Requirements for Human Drug Products and
Biological Products (Final Rule)
FORMS: NONE
OMB NO: 0910-0538 EXPIRATION DATE: 03/31/2007
RESPS:31,555 HOURS:1,023,310 COSTS(000):$0
Supplements and Other Changes to an Approved Application - Final
Rule
FORMS: NONE
OMB NO: 0910-0539 EXPIRATION DATE: 12/31/2007
RESPS:69 HOURS:69 COSTS(000):$0
Animal Drug User Fee Cover Sheet
FORMS: 3546
OMB NO: 0910-0540 EXPIRATION DATE: 12/31/2007
RESPS:30 HOURS:60 COSTS(000):$0
Guidance for Industry: Animal Drug User Fees and Fee Waivers and
Reductions
FORMS: NONE
OMB NO: 0910-0541 EXPIRATION DATE: 06/30/2007
RESPS:147 HOURS:147 COSTS(000):$0
Preparing a Claim of Categorical Exclusion or an Environmental
Assessment for Submission to the Center for Food Safety and
Applied Nutrition
FORMS: NONE
OMB NO: 0910-0543 EXPIRATION DATE: 05/31/2007
RESPS:1,274,272 HOURS:866,240 COSTS(000):$0
Eligibility Determination for Donors of Human Cells, Tissues,
and Cellular and Tissue-Based Products (HCT/Ps)
FORMS: NONE
OMB NO: 0910-0545 EXPIRATION DATE: 09/30/2007
RESPS:4,600 HOURS:1,083 COSTS(000):$0
Health and Diet Survey -- 2004 Supplement
FORMS: NONE
OMB NO: 0910-0546 EXPIRATION DATE: 11/30/2006
RESPS:6 HOURS:13,000 COSTS(000):$0
Food Additive Petitions, 21 CFR Part 571, Center for Veterinary
Medicine
FORMS: NONE
OMB NO: 0910-0548 EXPIRATION DATE: 08/31/2006
RESPS:1 HOURS:71 COSTS(000):$0
Requirements for Collection of Data Relating to the Prevention
of Medical Gas Mix-ups at Health Care Facilities Survey
FORMS: NONE
OMB NO: 0910-0549 EXPIRATION DATE: 06/30/2008
RESPS:1 HOURS:1 COSTS(000):$0
Irradiation in the Production, Processing and Handling of Food
FORMS: NONE
OMB NO: 0910-0551 EXPIRATION DATE: 02/29/2008
RESPS:100 HOURS:100 COSTS(000):$0
Application for Participation in the Medical Device Fellowship
Program; Form FDA 3608
FORMS: FDA-3608
OMB NO: 0910-0553 EXPIRATION DATE: 10/31/2007
RESPS:1,742 HOURS:34,840 COSTS(000):$0
Use of Symbols on Labels and in Labeling of In Vitro Diagnostic
Devices Intended for Professional Use
FORMS: NONE
OMB NO: 0910-0555 EXPIRATION DATE: 11/30/2007
RESPS:190 HOURS:27,740 COSTS(000):$0
SPresubmission Conferences - Final Rule
FORMS: NONE
OMB NO: 0910-0557 EXPIRATION DATE: 12/31/2007
RESPS:80 HOURS:6,400 COSTS(000):$0
Guidance for Industry - Pharmacogenomic Data Submissions
FORMS: NONE
OMB NO: 0910-0558 EXPIRATION DATE: 12/31/2007
RESPS:15,978 HOURS:7,669 COSTS(000):$0
Infant Feeding Practices Study II
FORMS: NONE
OMB NO: 0910-0559 EXPIRATION DATE: 11/30/2007
RESPS:23,731 HOURS:283,400 COSTS(000):$0
Current Good Tissue Practice for Human Cell, Tissue, and
Cellular and Tissue-Based Product Establishments; Inspection and
Enforcement
FORMS: NONE
OMB NO: 0910-0560 EXPIRATION DATE: 02/29/2008
RESPS:707,672 HOURS:5,359,000 COSTS(000):$6,646
Recordkeeping and Records Access Requirements for Food Facilities
FORMS: NONE
OMB NO: 0910-0562 EXPIRATION DATE: 05/31/2008
RESPS:652 HOURS:2,998 COSTS(000):$32
Channels of Trade Policy for Commodities with Residues of
Pesticide Chemicals for Which Tolerances Have Been Rovoked,
Suspended, or Modified by the EPA
FORMS: NONE
OMB NO: 0910-0563 EXPIRATION DATE: 05/31/2008
RESPS:30 HOURS:790 COSTS(000):$0
Guidance for Industry: Formal Dispute Resolution; Scientific and
Technical Issues Related to Pharmaceutical Current Good
Manufacturing Practice
FORMS: NONE
OMB NO: 0910-0564 EXPIRATION DATE: 05/31/2008
RESPS:300 HOURS:54,000 COSTS(000):$0
Performance Standard for Diagnostic X-Ray Systems and Their
Major Components
FORMS: NONE
OMB NO: 0910-0565 EXPIRATION DATE: 08/31/2008
RESPS:2,880 HOURS:1,827 COSTS(000):$0
Experimental Study of Health Claims on Food Packages
FORMS: NONE
OMB NO: 0910-0566 EXPIRATION DATE: 06/30/2008
RESPS:2 HOURS:60 COSTS(000):$0
Dispute Resolution Procedures for Science Based Decisions on
Products Regulated by the CVM
FORMS: NONE
OMB NO: 0910-0567 EXPIRATION DATE: 07/31/2008
RESPS:5,060 HOURS:845 COSTS(000):$0
Allergen Labeling of Food Products Consumer Preference Survey
and Experimental Study on Allergen Labeling of Food Products
FORMS: NONE
OMB NO: 0910-0569 EXPIRATION DATE: 08/31/2008
RESPS:15 HOURS:1,500 COSTS(000):$0
Requests for Inspection by an Accredited Person under the
Inspection by Accredited Persons Program
FORMS: NONE
OMB NO: 0910-0570 EXPIRATION DATE: 12/31/2008
RESPS:10,000 HOURS:2,731 COSTS(000):$0
Experimental Study of Carbohydrate Content Claims on Food Labels
FORMS: NONE
OMB NO: 0910-0571 EXPIRATION DATE: 05/31/2008
RESPS:900 HOURS:4,500 COSTS(000):$0
Guidance for Requesting an Extension to Use Existing Label Stock
After The Trans Fat Labeling Effective Date of January 1, 2006
FORMS: NONE
OMB NO: 0910-0572 EXPIRATION DATE: 01/31/2009
RESPS:1,911 HOURS:501,383 COSTS(000):$0
Requirements on Content and Format of Labeling for Human
Prescription Drug and Biological Products, Final Rule
FORMS: NONE
OMB NO: 0910-0575 EXPIRATION DATE: 01/31/2009
RESPS:18 HOURS:265 COSTS(000):$0
Waivers of Invivo Demonstration of Bioequivalence of Animal
Drugs in Soluble Powder Oral Dosage Form and Type a Medicated
Articles
FORMS: NONE
OMB NO: 0910-0577 EXPIRATION DATE: 01/31/2009
RESPS:300 HOURS:30 COSTS(000):$0
Reprocessed Single-Use Device Labeling
FORMS: NONE
OMB NO: 0910-0578 EXPIRATION DATE: 03/31/2009
RESPS:36,500,000 HOURS:5,400,000 COSTS(000):$0
Voluntary Hazard Analysis and Critical Control Point Manuals for
Operators and Regulators of Retail and Food Service
Establishments
FORMS: NONE
OMB NO: 0910-0579 EXPIRATION DATE: 03/31/2009
RESPS:144 HOURS:144 COSTS(000):$0
Research Study Complaint Form
FORMS: NONE
OMB NO: 0910-0580 EXPIRATION DATE: 03/31/2009
RESPS:1,007 HOURS:1,194 COSTS(000):$0
The Mammography Quality Standards Act Final Regulations:
Modifications and Aditions to Policy Guidance Help System #9
FORMS: NONE
OMB NO: 0910-0581 EXPIRATION DATE: 03/31/2009
RESPS:1,148 HOURS:1,795 COSTS(000):$0
Guidance for Industry: Clinical Trial Sponsors on the
Establishment and Operation of Clinical Trial Data Monitoring
Committees
FORMS: NONE
OMB NO: 0910-0582 EXPIRATION DATE: 09/30/2006
RESPS:600 HOURS:2,400 COSTS(000):$0
Guidance on Informed Consent for in Vitro Diagnostic Studies
Using Leftover Human Specimens that are not Individually
Identifiable
FORMS: NONE
OMB NO: 0910-0583 EXPIRATION DATE: 04/30/2009
RESPS:20 HOURS:400 COSTS(000):$0
Recommendations for Early Food Safety Evaluation of New
Non-Pesticidal Proteins Produced by New Plan Varieties Intended
for Food Use
FORMS: NONE
OMB NO: 0910-0584 EXPIRATION DATE: 12/31/2006
RESPS:20 HOURS:200 COSTS(000):$0
Emergency Request: Guidance for Reagents for Detection of
Specific Novel Influenza A Viruses
FORMS: NONE
OMB NO: 0910-0586 EXPIRATION DATE: 11/30/2006
RESPS:450 HOURS:900 COSTS(000):$0
Medical Devices; Exception from General Requirements for
Informed Consent
FORMS: NONE
OMB NO: 0910-0588 EXPIRATION DATE: 05/31/2009
RESPS:300 HOURS:100 COSTS(000):$0
Survey of Healthcare Practitioners Regarding Their Preferences
for Public Health Notifications
FORMS: NONE
OMB NO: 0910-0591 EXPIRATION DATE: 05/31/2009
RESPS:1 HOURS:156 COSTS(000):$0
Evaluation of Consumer-Friendly Formats for Brief Summary in
Direct-to-Consumer (DTC) Print Advertisements for Prescription
Drugs: Study 1
FORMS: NONE
OMB NO: 0910-0593 EXPIRATION DATE: 12/31/2006
RESPS:96 HOURS:48 COSTS(000):$0
MedWatch - The FDA Safety Information and Adverse Event
Reporting Program; Proposal to Survey MedWatch Partners
Organizations - Survey
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
167 278,535,518 152,778,424 $257,001
Health Services Administration
OMB NO: 0915-0034 EXPIRATION DATE: 08/31/2006
RESPS:16,400 HOURS:1,652 COSTS(000):$0
Health Education Assistance Loan (HEAL) Program: Forms
FORMS: HRSA-504
OMB NO: 0915-0036 EXPIRATION DATE: 09/30/2008
RESPS:20,960 HOURS:3,767 COSTS(000):$7
Health Education Assistance Loan (HEAL) Program: Lender's
Application for Insurance Claim Form and Request for Collection
Assistance Form
FORMS: NONE
OMB NO: 0915-0043 EXPIRATION DATE: 12/31/2006
RESPS:10,070 HOURS:5,055 COSTS(000):$0
Health Education Assistance Loan (HEAL)
FORMS: HRSA-502-1
OMB NO: 0915-0044 EXPIRATION DATE: 03/31/2009
RESPS:3,977 HOURS:4,408 COSTS(000):$0
Health Professions Student Loan and Nursing Student Loan
Programs - Forms
FORMS: HRSA-501 HRSA-519
OMB NO: 0915-0047 EXPIRATION DATE: 10/31/2008
RESPS:133,075 HOURS:52,690 COSTS(000):$0
Health Professions Student Loan (HPSL) Program and Nursing
Student Loan (NSL) Program: Administrative Requirements (Regs. &
Policy)
FORMS: NONE
OMB NO: 0915-0060 EXPIRATION DATE: 08/31/2006
RESPS:1,805 HOURS:101,531 COSTS(000):$27
HRSA Competing Training Grant Application
FORMS: PHS-6025-1
OMB NO: 0915-0061 EXPIRATION DATE: 01/31/2008
RESPS:1,550 HOURS:33,325 COSTS(000):$0
The Uniform Progress Reports (UPR) for HRSA Continuation
Training Grants
FORMS: NONE
OMB NO: 0915-0077 EXPIRATION DATE: 04/30/2009
RESPS:29,208 HOURS:33,040 COSTS(000):$0
Uncompensated Services Assurance Report
FORMS: HRSA-710
OMB NO: 0915-0099 EXPIRATION DATE: 11/30/2006
RESPS:10 HOURS:12 COSTS(000):$0
Grants for Hospital Construction and Modernization - Federal
Right of Recovery and Waiver of Recovery
FORMS: NONE
OMB NO: 0915-0108 EXPIRATION DATE: 01/31/2007
RESPS:280,793 HOURS:74,918 COSTS(000):$0
Health Education Assistance Loan (HEAL) Program Regs.
FORMS: NONE
OMB NO: 0915-0126 EXPIRATION DATE: 05/31/2007
RESPS:3,319,694 HOURS:293,589 COSTS(000):$13,508
National Practitioner Data Bank for Adverse Information on
Physicians and Other Health Care Practitioners: Regulations and
Forms
FORMS: NONE
OMB NO: 0915-0127 EXPIRATION DATE: 08/31/2007
RESPS:1,500 HOURS:2,163 COSTS(000):$0
The National Health Service Corps (NHSC) Loan Repayment Program
FORMS: HRSA-873
OMB NO: 0915-0140 EXPIRATION DATE: 11/30/2007
RESPS:9,200 HOURS:54,000 COSTS(000):$0
The Nursing Education Loan Repayment Program
FORMS: NONE
OMB NO: 0915-0142 EXPIRATION DATE: 10/31/2008
RESPS:140 HOURS:5,500 COSTS(000):$0
Application for Certification as a Federally Qualified Health
Center Look-Alike
FORMS: NONE
OMB NO: 0915-0146 EXPIRATION DATE: 11/30/2006
RESPS:3,100 HOURS:3,100 COSTS(000):$8
Application for Participation in the National Health Service
Corps Scholarship Program
FORMS: HRSA-856
OMB NO: 0915-0149 EXPIRATION DATE: 12/31/2006
RESPS:450 HOURS:10,575 COSTS(000):$0
Scholarships for Disadvantaged Students (SDS) Graduate Survey
FORMS: NONE
OMB NO: 0915-0150 EXPIRATION DATE: 09/30/2006
RESPS:94 HOURS:94 COSTS(000):$0
Faculty Loan Repayment Program Application
FORMS: HRSA-535
OMB NO: 0915-0151 EXPIRATION DATE: 06/30/2008
RESPS:125 HOURS:2,500 COSTS(000):$0
Ryan White CARE Act Dental Reimbursement Program
FORMS: NONE
OMB NO: 0915-0157 EXPIRATION DATE: 08/31/2007
RESPS:559,762 HOURS:84,057 COSTS(000):$0
Organ Procurement and Transplantation Network and Scientific
Registry of Transplant Recipients Data System
FORMS: NONE
OMB NO: 0915-0172 EXPIRATION DATE: 05/31/2009
RESPS:59 HOURS:18,064 COSTS(000):$0
Maternal and Child Health Services Block Grant Report
FORMS: NONE
OMB NO: 0915-0174 EXPIRATION DATE: 08/31/2006
RESPS:125 HOURS:125 COSTS(000):$0
Loan Information System Records for the DHHS DHUD Hospital
Mortgage Insurance, Guarantee, and Direct Loan Program
FORMS: HRSA-906
OMB NO: 0915-0176 EXPIRATION DATE: 11/30/2006
RESPS:8 HOURS:134 COSTS(000):$0
Drug Pricing Program Reporting Requirements
FORMS: NONE
OMB NO: 0915-0179 EXPIRATION DATE: 06/30/2007
RESPS:700 HOURS:700 COSTS(000):$0
Deferment Request Form for the National Health Service Corps
Scholarship Program
FORMS: NONE
OMB NO: 0915-0184 EXPIRATION DATE: 12/31/2007
RESPS:36,457 HOURS:19,459 COSTS(000):$0
Organ Procurement and Transplantation Network
FORMS: NONE
OMB NO: 0915-0193 EXPIRATION DATE: 05/31/2007
RESPS:1,045 HOURS:27,090 COSTS(000):$14,000
Uniform Data System
FORMS: NONE
OMB NO: 0915-0204 EXPIRATION DATE: 05/31/2007
RESPS:282 HOURS:71 COSTS(000):$2
HEAL Program: Physician's Certification of Borrower's Total and
Permanent Disability
FORMS: 539
OMB NO: 0915-0208 EXPIRATION DATE: 12/31/2006
RESPS:308 HOURS:26 COSTS(000):$0
Professional Training and Information Questionnaire
FORMS: HRSA-551 HRSA-552
OMB NO: 0915-0212 EXPIRATION DATE: 04/30/2009
RESPS:52,050 HOURS:5,075 COSTS(000):$0
Voluntary Partner Surveys to Implement Executive Order 12862 in
the Health Resources and Services Administration
FORMS: NONE
OMB NO: 0915-0230 EXPIRATION DATE: 08/31/2008
RESPS:2,900 HOURS:1,450 COSTS(000):$0
NHSC Recruitment and Retention Assistance Application
FORMS: NONE
OMB NO: 0915-0232 EXPIRATION DATE: 10/31/2008
RESPS:900 HOURS:32,400 COSTS(000):$83
National Health Service Corps - Uniform Data System
FORMS: NONE
OMB NO: 0915-0233 EXPIRATION DATE: 09/30/2008
RESPS:150 HOURS:825 COSTS(000):$0
Disadvantaged Assistance Tracking and Outcome Report (DATOR) for
Health Careers Opportunity Program and Centers of Excellence
Program
FORMS: NONE
OMB NO: 0915-0239 EXPIRATION DATE: 08/31/2007
RESPS:946,515 HOURS:116,146 COSTS(000):$4,074
Health Integrity and Protection Data Bank for Final Adverse
Information on Health Care Providers, Suppliers and Practitioners
FORMS: NONE
OMB NO: 0915-0247 EXPIRATION DATE: 01/31/2007
RESPS:60 HOURS:3,840 COSTS(000):$0
Children's Hospital Graduate Medical Eduction Program
FORMS: NONE
OMB NO: 0915-0250 EXPIRATION DATE: 06/30/2007
RESPS:1,350 HOURS:276 COSTS(000):$0
The National Health Service Corps Scholarship Program In-School
Worksheets
FORMS: NONE
OMB NO: 0915-0253 EXPIRATION DATE: 12/31/2007
RESPS:3,367 HOURS:107,636 COSTS(000):$0
Ryan White Comprehensive Aids Resources Emergency Act of 1990,
CARE Act Data Report (CADR) System
FORMS: NONE
OMB NO: 0915-0262 EXPIRATION DATE: 12/31/2006
RESPS:212 HOURS:3,816 COSTS(000):$0
Office of State and National Partnership's Web-based Semi Annual
Report
FORMS: NONE
OMB NO: 0915-0268 EXPIRATION DATE: 02/28/2009
RESPS:86 HOURS:688 COSTS(000):$0
Implementation of the Primary Care Surveillance System (PSCC)
Core Data Collection Effort for the Sentinal Centers Network
(SCN)
FORMS: NONE
OMB NO: 0915-0275 EXPIRATION DATE: 12/31/2007
RESPS:16,800 HOURS:25,200 COSTS(000):$0
Ryan White Comprehensive Aids Resources Emergency Act of 1990,
Title III and IV Client-Level Data Project (CDP) Reporting System
FORMS: NONE
OMB NO: 0915-0278 EXPIRATION DATE: 10/31/2006
RESPS:622 HOURS:41 COSTS(000):$0
NHSC Travel Request Worksheet
FORMS: NONE
OMB NO: 0915-0281 EXPIRATION DATE: 12/31/2006
RESPS:13,536 HOURS:32,502 COSTS(000):$0
AIDS Education and Training Centers
FORMS: NONE
OMB NO: 0915-0282 EXPIRATION DATE: 08/31/2007
RESPS:2,500 HOURS:7,500 COSTS(000):$0
Smallpox Vaccine Injury Compensation Program
FORMS: NONE
OMB NO: 0915-0285 EXPIRATION DATE: 06/30/2007
RESPS:1,425 HOURS:59,375 COSTS(000):$0
The Presidential Initiative Applications for Funding
Opportunities
FORMS: NONE
OMB NO: 0915-0286 EXPIRATION DATE: 06/30/2007
RESPS:4 HOURS:18 COSTS(000):$0
Organ Procurement and Transplantation Network (42 CFR Part
121.3(b)(4) and 121.9(d))
FORMS: NONE
OMB NO: 0915-0289 EXPIRATION DATE: 09/30/2007
RESPS:314 HOURS:14,130 COSTS(000):$0
Health Care Infrastructure Application Forms for Funding
Opportunities
FORMS: NONE
OMB NO: 0915-0292 EXPIRATION DATE: 09/30/2007
RESPS:15 HOURS:150 COSTS(000):$0
Black Lung Clinics Program Database
FORMS: NONE
OMB NO: 0915-0293 EXPIRATION DATE: 08/31/2008
RESPS:150 HOURS:2,400 COSTS(000):$0
Free Clinics FTCA Program Application
FORMS: NONE
OMB NO: 0915-0294 EXPIRATION DATE: 01/31/2008
RESPS:228 HOURS:428 COSTS(000):$0
HRSA AIDS Drug Assistance Quarterly Report
FORMS: NONE
OMB NO: 0915-0295 EXPIRATION DATE: 02/29/2008
RESPS:4,900 HOURS:2,750 COSTS(000):$0
Grant Reviewer Recruitment Form
FORMS: NONE
OMB NO: 0915-0297 EXPIRATION DATE: 09/30/2006
RESPS:126 HOURS:108 COSTS(000):$0
Survey of Universal Newborn Hearing Screening and Intervention
Programs
FORMS: NONE
OMB NO: 0915-0298 EXPIRATION DATE: 03/31/2009
RESPS:631 HOURS:3,786 COSTS(000):$0
Maternal and Child Health Bureau Performance Measures for
Discretionary Grants
FORMS: NONE
OMB NO: 0915-0300 EXPIRATION DATE: 06/30/2007
RESPS:633 HOURS:316 COSTS(000):$0
Healthy Start Participant Survey
FORMS: NONE
OMB NO: 0915-0301 EXPIRATION DATE: 07/31/2009
RESPS:5,000 HOURS:4,750 COSTS(000):$0
The Nursing Scholarship Program
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
52 5,485,371 1,257,251 $31,709
Indian Health Service
OMB NO: 0917-0002 EXPIRATION DATE: 11/30/2006
RESPS:338,403 HOURS:16,920 COSTS(000):$0
IHS Contract Health Service Purchase-Delivery Order for Health
Service
FORMS: IHS843-1A
OMB NO: 0917-0006 EXPIRATION DATE: 09/30/2007
RESPS:17,330 HOURS:5,536 COSTS(000):$0
IHS Scholarship Program Application
FORMS: 856 856-2 856-3 856-4 856-5 856-6
OMB NO: 0917-0007 EXPIRATION DATE: 09/30/2007
RESPS:34 HOURS:514 COSTS(000):$0
IHS Urban Indian Health Program Common Reporting Requirements
FORMS: NONE
OMB NO: 0917-0009 EXPIRATION DATE: 08/31/2006
RESPS:3,709 HOURS:2,371 COSTS(000):$0
Indian Health Service Medical Staff Credentials and Privileges
Files
FORMS: NONE
OMB NO: 0917-0014 EXPIRATION DATE: 12/31/2008
RESPS:2,125 HOURS:1,382 COSTS(000):$0
Indian Health Service Loan Repayment Program
FORMS: NONE
OMB NO: 0917-0025 EXPIRATION DATE: 05/31/2007
RESPS:1 HOURS:384 COSTS(000):$0
Hoz'ho'nii: An Intervention to Increase Breat and Cervical
Cancer Screening Among Navajo Women
FORMS: NONE
OMB NO: 0917-0026 EXPIRATION DATE: 12/31/2008
RESPS:50 HOURS:3,720 COSTS(000):$0
Final Rule to Implement Title V of the Tribal Self-Governance
Amendments of 2000
FORMS: NONE
OMB NO: 0917-0028 EXPIRATION DATE: 02/28/2009
RESPS:2,000 HOURS:500 COSTS(000):$0
IHS Background Investigations of Individuals in Positions
Involving Regular Contact with or Control Over Indian Children
FORMS: 306
OMB NO: 0917-0030 EXPIRATION DATE: 08/31/2006
RESPS:542,500 HOURS:174,375 COSTS(000):$0
IHS Forms To Implement The Privacy Rule (45 CFR Parts 160 and
164)
FORMS: NONE
OMB NO: 0917-0031 EXPIRATION DATE: 07/31/2007
RESPS:108 HOURS:18 COSTS(000):$0
Chief Executive Officer Retention Survey
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
10 906,260 205,720 $0
Centers for Disease Control and Prevention
OMB NO: 0920-0004 EXPIRATION DATE: 10/31/2006
RESPS:1,277 HOURS:12,732 COSTS(000):$0
National Disease Surveillance Program - II. Disease Summaries
FORMS: CDC-52.12 52.13 52.19 52.20 52.28 55.41 55.9 55.20 55.31
55.31A/55.83A-C
OMB NO: 0920-0006 EXPIRATION DATE: 02/28/2009
RESPS:600 HOURS:167 COSTS(000):$16
Application for Waiver of Inadmissibility Under Immigration and
Nationality Act
FORMS: CDC-4.422-1 CDC-4.422-1A CDC-4.422-1B
OMB NO: 0920-0007 EXPIRATION DATE: 07/31/2007
RESPS:12,329 HOURS:5,455 COSTS(000):$0
Weekly and Annual Morbidity and Mortality Reports
FORMS: CDC43.5A
OMB NO: 0920-0008 EXPIRATION DATE: 09/30/2006
RESPS:15,000 HOURS:3,750 COSTS(000):$0
Emergency Epidemic Investigations
FORMS: NONE
OMB NO: 0920-0009 EXPIRATION DATE: 11/30/2006
RESPS:51,564 HOURS:14,508 COSTS(000):$0
National Disease Surveillance Program - 1. Case Reports
FORMS: CDC-53.1 CDC-52.15 CDC-56.31A CDC-56.31B CDC-55.54 CDC-52-56
CDC-52.18 CDC-52.60 CDC-54.1 CDC-56.37
OMB NO: 0920-0010 EXPIRATION DATE: 05/31/2009
RESPS:400 HOURS:600 COSTS(000):$0
National Birth Defects Prevention Study (formerly titled: Metro
Atlanta Birth Defects & Factor Surveillance Program)
FORMS: NONE
OMB NO: 0920-0012 EXPIRATION DATE: 02/29/2008
RESPS:83,890 HOURS:66,775 COSTS(000):$47,520
National Nosocomial Infections Surveillance System (NNIS)
FORMS: NONE
OMB NO: 0920-0017 EXPIRATION DATE: 12/31/2006
RESPS:45,525 HOURS:3,582 COSTS(000):$0
Application for Training
FORMS: CDC-FORM-32.1 CDC-FORM-36.5
OMB NO: 0920-0020 EXPIRATION DATE: 09/30/2007
RESPS:8,025 HOURS:1,246 COSTS(000):$0
National Coal Workers' X-ray Surveillance Program (CWXSP) -
Federal Mine Safety and Health Act 1977 (42CFR37)
FORMS: NIOSH(M)-2.8 NIOSH(M)-2.9 NIOSH(M)-2.10 NIOSH(M)-2.11
NIOSH(M)-2.12
OMB NO: 0920-0021 EXPIRATION DATE: 11/30/2006
RESPS:50 HOURS:21 COSTS(000):$0
National Coal Workers' Autopsy Study (42 cfr 37.204)
FORMS: CDC/NIOSH-2.6
OMB NO: 0920-0026 EXPIRATION DATE: 11/30/2008
RESPS:15,120 HOURS:7,560 COSTS(000):$0
National Tuberculosis Surveillance
FORMS: CDC-72.9A CDC-72.9B CDC-72.9C
OMB NO: 0920-0106 EXPIRATION DATE: 10/31/2008
RESPS:122 HOURS:4,270 COSTS(000):$0
Preventive Health and Health Services Block Grant
FORMS: NONE
OMB NO: 0920-0109 EXPIRATION DATE: 11/30/2007
RESPS:430 HOURS:98,470 COSTS(000):$0
Information Collection Provisions in 42 CFR Part 84 - Tests and
Requirements for Certification and Approval of Respiratory
Protective Devices
FORMS: NONE
OMB NO: 0920-0128 EXPIRATION DATE: 09/30/2006
RESPS:500 HOURS:130 COSTS(000):$0
Congenital Syphilis Case Investigation and Report Form
FORMS: CDC-73.126
OMB NO: 0920-0134 EXPIRATION DATE: 12/31/2008
RESPS:2,711,601 HOURS:225,759 COSTS(000):$0
Foreign Quarantine Regulations
FORMS: NONE
OMB NO: 0920-0138 EXPIRATION DATE: 02/29/2008
RESPS:67 HOURS:52 COSTS(000):$0
Pulmonary Function Testing Course Approval Program
FORMS: NONE
OMB NO: 0920-0199 EXPIRATION DATE: 08/31/2006
RESPS:4,452 HOURS:1,206 COSTS(000):$0
Importation and Transportation of Etiologic Agents (42 CFR 71.54
and Part 72)
FORMS: 0.753
OMB NO: 0920-0210 EXPIRATION DATE: 08/31/2007
RESPS:143 HOURS:930 COSTS(000):$0
List of Ingredients Added in the Manufacture of Cigarette
Products
FORMS: NONE
OMB NO: 0920-0212 EXPIRATION DATE: 08/31/2008
RESPS:47,525 HOURS:2,131 COSTS(000):$0
National Hospital Discharge Survey
FORMS: NONE
OMB NO: 0920-0213 EXPIRATION DATE: 02/28/2009
RESPS:1,150 HOURS:208 COSTS(000):$0
National Vital Statistics Report Forms
FORMS: CDC-64.147 CDC-64.146
OMB NO: 0920-0214 EXPIRATION DATE: 12/31/2007
RESPS:43,417 HOURS:36,821 COSTS(000):$0
National Health Interview Survey: Basic Module with 2005 Topical
Modules
FORMS: NONE
OMB NO: 0920-0215 EXPIRATION DATE: 11/30/2007
RESPS:780 HOURS:227 COSTS(000):$0
Application form and related forms for the operation of the
National Death Index
FORMS: CDC/NCHS-6205-1 CDC-64.24 CDC-64.25 PHS-6205-3 CDC/NCHS-6205-6
OMB NO: 0920-0217 EXPIRATION DATE: 07/31/2007
RESPS:157 HOURS:44 COSTS(000):$0
NCHS Application for Vital Statistics Training Form
FORMS: CDC-64.52
OMB NO: 0920-0222 EXPIRATION DATE: 01/31/2007
RESPS:460 HOURS:600 COSTS(000):$0
NCHS Questionnaire Design Research Laboratory
FORMS: NONE
OMB NO: 0920-0234 EXPIRATION DATE: 05/31/2007
RESPS:85,360 HOURS:7,460 COSTS(000):$0
NCHS National Ambulatory Medical Care Survey, 2005-2006
FORMS: CDC-64.148 CDC-64.149
OMB NO: 0920-0237 EXPIRATION DATE: 03/31/2007
RESPS:22,913 HOURS:63,092 COSTS(000):$0
NCHS National Health and Nutrition Examination Survey (NHANES)
2005-2006
FORMS: NONE
OMB NO: 0920-0255 EXPIRATION DATE: 08/31/2006
RESPS:19,133 HOURS:3,858 COSTS(000):$0
Resources and Services Database for the CDC National Prevention
Information Network
FORMS: NONE
OMB NO: 0920-0260 EXPIRATION DATE: 11/30/2007
RESPS:11,840 HOURS:3,991 COSTS(000):$0
Health Hazard Evaluations/Technical Assistance and Emerging
Problems
FORMS: NONE
OMB NO: 0920-0261 EXPIRATION DATE: 04/30/2007
RESPS:77 HOURS:10,631 COSTS(000):$0
NIOSH Training Grants Applications (42 CFR 86)
FORMS: CDC-2.145A CDC-2.145B
OMB NO: 0920-0263 EXPIRATION DATE: 05/31/2008
RESPS:100 HOURS:20 COSTS(000):$0
Requirements for a Special Permit to Import Cynomolgus, African
Green, or Rhesus Monkeys into the United States
FORMS: CDC-75.10A
OMB NO: 0920-0274 EXPIRATION DATE: 10/31/2007
RESPS:4,245 HOURS:1,057 COSTS(000):$0
CDC Model Performance Evaluation Program (MPEP) for Retroviral
and AIDS-Related Testing
FORMS: NONE
OMB NO: 0920-0278 EXPIRATION DATE: 05/31/2007
RESPS:94,970 HOURS:10,030 COSTS(000):$0
NCHS National Hospital Ambulatory Medical Care Survey, 2005-2006
FORMS: 101(CDC-64.151) 101U(CDC-64.150 CDC-64.136 CDC-64.135
OMB NO: 0920-0282 EXPIRATION DATE: 04/30/2007
RESPS:168 HOURS:336 COSTS(000):$0
The Childhood Lead Poisoning Prevention Program Quarterly Report
FORMS: NONE
OMB NO: 0920-0295 EXPIRATION DATE: 09/30/2006
RESPS:48,100 HOURS:1,342 COSTS(000):$0
National AIDS and STD Hotline Survey of Callers
FORMS: NONE
OMB NO: 0920-0298 EXPIRATION DATE: 07/31/2009
RESPS:12,320 HOURS:6,088 COSTS(000):$0
National Home and Hospice Care Survey
FORMS: NONE
OMB NO: 0920-0307 EXPIRATION DATE: 01/31/2008
RESPS:1,644 HOURS:8,142 COSTS(000):$0
Gonococcal Isolate Surveillance Project
FORMS: CDC-73.60A 73.60B 73.60C
OMB NO: 0920-0314 EXPIRATION DATE: 04/30/2009
RESPS:14,970 HOURS:6,457 COSTS(000):$0
National Survey of Family Growth, Cycle 7
FORMS: NONE
OMB NO: 0920-0334 EXPIRATION DATE: 11/30/2008
RESPS:70,272 HOURS:11,231 COSTS(000):$0
National Survey of Ambulatory Surgery
FORMS: NONE
OMB NO: 0920-0337 EXPIRATION DATE: 05/31/2008
RESPS:336 HOURS:672 COSTS(000):$0
National Blood Lead Surveillance System
FORMS: NONE
OMB NO: 0920-0338 EXPIRATION DATE: 08/31/2007
RESPS:11 HOURS:18,838 COSTS(000):$0
List of Ingredients Added in the Manufacture of Smokeless
Tobacco Products
FORMS: NONE
OMB NO: 0920-0353 EXPIRATION DATE: 05/31/2007
RESPS:29,250 HOURS:13,375 COSTS(000):$0
National Nursing Home Survey
FORMS: NONE
OMB NO: 0920-0406 EXPIRATION DATE: 11/30/2007
RESPS:620,325 HOURS:55,190 COSTS(000):$0
State and Local Area Integrated Telephone Survey (SLAITS)
FORMS: NONE
OMB NO: 0920-0417 EXPIRATION DATE: 02/29/2008
RESPS:1,349 HOURS:17,907 COSTS(000):$15
National Surveillance System for Health Care Workers
FORMS: NONE
OMB NO: 0920-0428 EXPIRATION DATE: 08/31/2006
RESPS:21,379 HOURS:49,049 COSTS(000):$0
PHS Supplements to Application for Federal Assistance (SF 424)
FORMS: SF-424 PHS-5161-1 CDC.124(E) CDC.0113 OPHS-1
OMB NO: 0920-0442 EXPIRATION DATE: 08/31/2006
RESPS:223 HOURS:6,300 COSTS(000):$0
Surveillance for Bloodstream and Vascular Access Infections in
Outpatient Hemodialysis Centers
FORMS: NONE
OMB NO: 0920-0445 EXPIRATION DATE: 11/30/2008
RESPS:19.086 HOURS:22,812 COSTS(000):$0
School Health Policies and Programs Study 2006 (SHPPS 2006)
FORMS: NONE
OMB NO: 0920-0457 EXPIRATION DATE: 08/31/2006
RESPS:68 HOURS:340 COSTS(000):$0
Aggregate Reports for Tuberculosis Program Evaluation
FORMS: NONE
OMB NO: 0920-0463 EXPIRATION DATE: 04/30/2009
RESPS:100 HOURS:50 COSTS(000):$0
Longitudinal Surveillance for Beryllium Disease Prevention
FORMS: NONE
OMB NO: 0920-0469 EXPIRATION DATE: 11/30/2006
RESPS:63 HOURS:126 COSTS(000):$0
National Program of Cancer Registries Cancer Surveillance System
FORMS: NONE
OMB NO: 0920-0472 EXPIRATION DATE: 09/30/2006
RESPS:16,749 HOURS:2,689 COSTS(000):$0
Assessment of Exposure to Aresenic Through Household Water
FORMS: NONE
OMB NO: 0920-0479 EXPIRATION DATE: 08/31/2006
RESPS:59 HOURS:236 COSTS(000):$1
Automated Management Information System (MIS) for Diabetes
Control Programs
FORMS: NONE
OMB NO: 0920-0487 EXPIRATION DATE: 09/30/2006
RESPS:745 HOURS:173 COSTS(000):$0
Risk Factors for Microbial Contamination of Produce: A Field
Study of Domestic and Imported Produce in Packing Sheds
FORMS: NONE
OMB NO: 0920-0488 EXPIRATION DATE: 12/31/2006
RESPS:16,500 HOURS:3,600 COSTS(000):$0
Restrictions on Interstate Travel of Persons
FORMS: NONE
OMB NO: 0920-0489 EXPIRATION DATE: 04/30/2008
RESPS:3,960 HOURS:3,960 COSTS(000):$0
US-MX Border Diabetes Prevention and Control Project - Phase 2
Community Intervention Pilot Study
FORMS: NONE
OMB NO: 0920-0493 EXPIRATION DATE: 11/30/2007
RESPS:8,230 HOURS:6,115 COSTS(000):$0
2005 and 2007 Youth Risk Behavior Surveys
FORMS: NONE
OMB NO: 0920-0494 EXPIRATION DATE: 12/31/2008
RESPS:605 HOURS:128 COSTS(000):$0
Exposure to Aerosolized Brevetoxins During Red Tide Events
FORMS: NONE
OMB NO: 0920-0499 EXPIRATION DATE: 08/31/2007
RESPS:80 HOURS:800 COSTS(000):$0
Jail STD Prevalence Monitoring System
FORMS: NONE
OMB NO: 0920-0502 EXPIRATION DATE: 06/30/2007
RESPS:29,647 HOURS:8,138 COSTS(000):$0
REACH 2010 Evaluation
FORMS: NONE
OMB NO: 0920-0527 EXPIRATION DATE: 02/28/2007
RESPS:638 HOURS:231 COSTS(000):$0
Human Exposure to Cynobacterial (Blue-green Algal) Toxins in
Drinking Water: Risk of Exposure to Microcystins from Public
Water Systems
FORMS: NONE
OMB NO: 0920-0530 EXPIRATION DATE: 01/31/2009
RESPS:12,600 HOURS:4,900 COSTS(000):$0
EEOICPA Dose Reconstruction Interviews and Form
FORMS: OCAS-1
OMB NO: 0920-0555 EXPIRATION DATE: 12/31/2008
RESPS:175 HOURS:4,200 COSTS(000):$0
National Public Health Performance Standards Program Local
Public Health Performance Assessment
FORMS: NONE
OMB NO: 0920-0556 EXPIRATION DATE: 08/31/2006
RESPS:400 HOURS:63,400 COSTS(000):$0
Assisted Reproductive Technology (ART) Program Reporting System
FORMS: NONE
OMB NO: 0920-0557 EXPIRATION DATE: 12/31/2008
RESPS:7 HOURS:105 COSTS(000):$0
National Public Health Performance Standards Program State
Public Health Performance Assessment
FORMS: NONE
OMB NO: 0920-0571 EXPIRATION DATE: 11/30/2006
RESPS:273 HOURS:2,343 COSTS(000):$0
Minimum Data Elements/System for Technical Assistance Reporting
for the National Breast and Cervical Cancer Early Detection
Program
FORMS: NONE
OMB NO: 0920-0572 EXPIRATION DATE: 06/30/2008
RESPS:6,400 HOURS:2,500 COSTS(000):$0
CDC and ATSDR Health Massage Testing System
FORMS: NONE
OMB NO: 0920-0573 EXPIRATION DATE: 11/30/2006
RESPS:79,981 HOURS:13,191 COSTS(000):$0
Adult and Pediatric Confidential HIV/AIDS Case Report
FORMS: CDC-50.42A CDC-50.42B
OMB NO: 0920-0576 EXPIRATION DATE: 03/31/2009
RESPS:5,324 HOURS:7,785 COSTS(000):$0
Possession, Use, and Transfer of Select Agents and Toxins (42
CFR 73)
FORMS: 0.1316 0.1317 0.1318 0.1319 EA-101
OMB NO: 0920-0580 EXPIRATION DATE: 12/31/2006
RESPS:1,067 HOURS:6,402 COSTS(000):$0
National Public Health Performance Standards Program Local
Public Health Governance Performance Assessment Tool
FORMS: NONE
OMB NO: 0920-0582 EXPIRATION DATE: 05/31/2007
RESPS:33,127 HOURS:2,362 COSTS(000):$0
YMC Tracking Study
FORMS: NONE
OMB NO: 0920-0587 EXPIRATION DATE: 11/30/2006
RESPS:29,490 HOURS:4,887 COSTS(000):$0
Outcome Follow-up Survey of CDC's Youth Media Campaign
FORMS: NONE
OMB NO: 0920-0591 EXPIRATION DATE: 09/30/2007
RESPS:900 HOURS:450 COSTS(000):$0
Select Agent Distribution Activity; Request for Select Agent
FORMS: NONE
OMB NO: 0920-0595 EXPIRATION DATE: 12/31/2006
RESPS:900 HOURS:175 COSTS(000):$0
HIV Rapid Testing Performance Evaluation Sample and Laboratory
Practices Questionnaire Surveys
FORMS: NONE
OMB NO: 0920-0596 EXPIRATION DATE: 09/30/2007
RESPS:5,700 HOURS:1,583 COSTS(000):$0
Severe Acute Respiratory Syndrome (SARS) Investigation
FORMS: NONE
OMB NO: 0920-0599 EXPIRATION DATE: 09/30/2007
RESPS:1,070 HOURS:555 COSTS(000):$0
A Community-Based Intervention Model to Promote Neighborhood
Participation in the Reduction of Aedes aegypti indices in
Puerto Rico
FORMS: CDC-50.133
OMB NO: 0920-0600 EXPIRATION DATE: 09/30/2006
RESPS:330 HOURS:165 COSTS(000):$0
Centers for Disease Control and Prevention Performance
Evaluation Program for Mycobacterium
Tuberculosis/Non-tuberculosis Mycobacteria Drug Susceptibility
Testing Program
FORMS: NONE
OMB NO: 0920-0601 EXPIRATION DATE: 08/31/2006
RESPS:102 HOURS:612 COSTS(000):$0
National Tobacco Control Program Chronicle Progress Reporting
System
FORMS: NONE
OMB NO: 0920-0602 EXPIRATION DATE: 10/31/2006
RESPS:90,048 HOURS:28,860 COSTS(000):$0
Work and Health Study: Risk Factors for Heart Disease and
Depression in the Workplace
FORMS: NONE
OMB NO: 0920-0603 EXPIRATION DATE: 09/30/2006
RESPS:84 HOURS:84 COSTS(000):$0
Racial and Ethnic Approaches to Community Health 2010
Information Network (REACH IN)
FORMS: NONE
OMB NO: 0920-0604 EXPIRATION DATE: 11/30/2006
RESPS:70 HOURS:70 COSTS(000):$0
School-Associated Violent Deaths Surveillance System
FORMS: NONE
OMB NO: 0920-0607 EXPIRATION DATE: 11/30/2006
RESPS:20,000 HOURS:25,000 COSTS(000):$0
The National Violent Death Reporting System (NVDRS)
FORMS: NONE
OMB NO: 0920-0610 EXPIRATION DATE: 12/31/2006
RESPS:650 HOURS:325 COSTS(000):$0
Evaluation of the Process Required to Effectively Expand the
National Laboratory System (NLS) to All States
FORMS: NONE
OMB NO: 0920-0612 EXPIRATION DATE: 11/30/2006
RESPS:150 HOURS:2,160 COSTS(000):$0
WISEWOMAN Reporting System
FORMS: NONE
OMB NO: 0920-0614 EXPIRATION DATE: 11/30/2006
RESPS:5 HOURS:120 COSTS(000):$0
International Performance Standards Project
FORMS: NONE
OMB NO: 0920-0621 EXPIRATION DATE: 12/31/2008
RESPS:25,037 HOURS:18,644 COSTS(000):$0
National Youth Tobacco Survey (NYTS)
FORMS: NONE
OMB NO: 0920-0622 EXPIRATION DATE: 01/31/2007
RESPS:532 HOURS:400 COSTS(000):$0
The Domestic Violence Prevention Enhancement and Leadership
through Alliances (DELTA) Program
FORMS: NONE
OMB NO: 0920-0624 EXPIRATION DATE: 10/31/2008
RESPS:667 HOURS:167 COSTS(000):$0
An Evaluation of the Use and Effectiveness of Internet SAMMEC
FORMS: NONE
OMB NO: 0920-0628 EXPIRATION DATE: 03/31/2007
RESPS:4,015 HOURS:6,030 COSTS(000):$0
Housing and Health Study
FORMS: NONE
OMB NO: 0920-0630 EXPIRATION DATE: 04/30/2007
RESPS:2,550 HOURS:1,892 COSTS(000):$0
Work Organization Predictors of Depression in Women
FORMS: NONE
OMB NO: 0920-0632 EXPIRATION DATE: 02/28/2007
RESPS:2,000 HOURS:400 COSTS(000):$0
Clinicians' Management Approach to Children with Pharyngitis
FORMS: NONE
OMB NO: 0920-0636 EXPIRATION DATE: 12/31/2007
RESPS:1,000 HOURS:167 COSTS(000):$0
State-Based Evaluation of the Alert Notification Component of
CDC's Secure Communications Network (EPI-X)
FORMS: NONE
OMB NO: 0920-0639 EXPIRATION DATE: 05/31/2007
RESPS:90 HOURS:54 COSTS(000):$0
EEOICPA Special Exposure Cohort Petition Forms (42 CFR Part 8)
FORMS: NONE
OMB NO: 0920-0641 EXPIRATION DATE: 09/30/2006
RESPS:217 HOURS:36 COSTS(000):$0
Descriptive Epidemiology of Missed or Delayed Diagnosis for
Conditions Detected by Newborn Screening
FORMS: NONE
OMB NO: 0920-0643 EXPIRATION DATE: 06/30/2007
RESPS:221,600 HOURS:17,026 COSTS(000):$0
Assessment Information About the National Center for Injury
Prevention and Control (NCIPC) Publications
FORMS: NONE
OMB NO: 0920-0646 EXPIRATION DATE: 08/31/2007
RESPS:31,325 HOURS:2,365 COSTS(000):$0
Cross-sectional Survey for the Evaluation of the CDC Youth Media
Campaign
FORMS: NONE
OMB NO: 0920-0648 EXPIRATION DATE: 07/31/2007
RESPS:100 HOURS:58 COSTS(000):$0
NCHS Technology and Aging Pilot Survey
FORMS: NONE
OMB NO: 0920-0649 EXPIRATION DATE: 09/30/2007
RESPS:29,125 HOURS:4,855 COSTS(000):$0
Assessment of Educational Materials and Information Distribution
Systems
FORMS: NONE
OMB NO: 0920-0650 EXPIRATION DATE: 11/30/2007
RESPS:132 HOURS:279 COSTS(000):$0
Prevention Research Centers Information System
FORMS: NONE
OMB NO: 0920-0651 EXPIRATION DATE: 07/31/2008
RESPS:240 HOURS:210 COSTS(000):$0
Evaluation of Educational Materials Promoting Informed Decision
Making About Prostate Cancer Screening - PHASE II: RCT
FORMS: 35038-25
OMB NO: 0920-0655 EXPIRATION DATE: 09/30/2006
RESPS:656 HOURS:100 COSTS(000):$0
Accommodation of Noise-Exposed, Hearing-Impaired Workers
FORMS: NONE
OMB NO: 0920-0658 EXPIRATION DATE: 11/30/2007
RESPS:3,060 HOURS:1,462 COSTS(000):$0
CDC HIV Prevention Capacity-Building Assistance (CBA)
Information Collection, Reporting, and Monitoring Forms
FORMS: NONE
OMB NO: 0920-0660 EXPIRATION DATE: 02/29/2008
RESPS:504 HOURS:109 COSTS(000):$0
Surveillance Survey for the Guide to Community Preventive
Services
FORMS: NONE
OMB NO: 0920-0662 EXPIRATION DATE: 01/31/2008
RESPS:56 HOURS:36 COSTS(000):$0
Learning from Principal Investigators of Research Projects
Funded through the Extramural Prevention Research Program: How
Can CDC Best Support Participatory Research and the....
FORMS: NONE
OMB NO: 0920-0666 EXPIRATION DATE: 02/29/2008
RESPS:174,395 HOURS:65,817 COSTS(000):$39,600
The National Healthcare Safety Network
FORMS: 57.75A-Z 57.75Z(1-3) 57.75AA-DD
OMB NO: 0920-0667 EXPIRATION DATE: 09/30/2006
RESPS:1,637 HOURS:250 COSTS(000):$0
Active Surveillance for Ciguatera Fish Poisoning in Culebra,
Puerto Rico
FORMS: NONE
OMB NO: 0920-0668 EXPIRATION DATE: 02/28/2007
RESPS:1,138 HOURS:570 COSTS(000):$0
Minority HIV/AIDS Research Initiative: "Access to HIV Testing
and Treatment in the Rural South"
FORMS: NONE
OMB NO: 0920-0669 EXPIRATION DATE: 01/31/2008
RESPS:40 HOURS:672 COSTS(000):$0
Evaluation of "State Nutrition and Physical Activity Programs to
Prevent Obesity and Other Chronic Diseases"
FORMS: NONE
OMB NO: 0920-0670 EXPIRATION DATE: 09/30/2006
RESPS:1,800 HOURS:300 COSTS(000):$0
Evaluation of Efficacy of Household Water Filtration/Treatment
Devices in Households with Private Wells
FORMS: NONE
OMB NO: 0920-0671 EXPIRATION DATE: 01/31/2008
RESPS:909 HOURS:609 COSTS(000):$0
American Indian and Alaska Native Adult Tobacco Surveys
FORMS: NONE
OMB NO: 0920-0672 EXPIRATION DATE: 02/29/2008
RESPS:96 HOURS:718 COSTS(000):$0
Indicators of the Performance of Local and State Education
Agencies in HIV Prevention and Coordinated School Health Program
Activities for Adolescent and School Health Programs
FORMS: NONE
OMB NO: 0920-0673 EXPIRATION DATE: 02/28/2007
RESPS:14,750 HOURS:1,750 COSTS(000):$0
ACHES (Arthritis Conditions Health Effects Survey)
FORMS: NONE
OMB NO: 0920-0674 EXPIRATION DATE: 01/31/2008
RESPS:4,045 HOURS:301 COSTS(000):$0
Evaluation of a Concussion Tool Kit - Heads Up: Concussion in
High School Sports
FORMS: NONE
OMB NO: 0920-0675 EXPIRATION DATE: 11/30/2006
RESPS:311 HOURS:156 COSTS(000):$0
Evaluation of the James A. Ferguson Emerging Infectious Diseases
Fellowship Program
FORMS: NONE
OMB NO: 0920-0677 EXPIRATION DATE: 02/29/2008
RESPS:140 HOURS:47 COSTS(000):$0
Sexually Transmitted Diseases Laboratory Test Method Survey
FORMS: NONE
OMB NO: 0920-0678 EXPIRATION DATE: 11/30/2006
RESPS:630 HOURS:158 COSTS(000):$0
Increasing Cervical Cancer Screening in Never or Rarely Screened
Black Women: Phase I
FORMS: NONE
OMB NO: 0920-0679 EXPIRATION DATE: 05/31/2008
RESPS:132 HOURS:396 COSTS(000):$0
Cardiovascular Health Branch Management Information System
FORMS: NONE
OMB NO: 0920-0680 EXPIRATION DATE: 10/31/2008
RESPS:108 HOURS:18 COSTS(000):$0
Severe Acute Respitory Syndrome (SARS) Model Performance
Evaluation Program (MPEP)
FORMS: NONE
OMB NO: 0920-0681 EXPIRATION DATE: 02/28/2007
RESPS:115 HOURS:145 COSTS(000):$0
Comprehensive Cancer Control: Implementation Case Studies
FORMS: NONE
OMB NO: 0920-0682 EXPIRATION DATE: 12/31/2006
RESPS:344 HOURS:460 COSTS(000):$0
Assessment of Occupational Exposures to Electric and Magnetic
Fields (EMF)
FORMS: NONE
OMB NO: 0920-0684 EXPIRATION DATE: 08/31/2007
RESPS:20,920 HOURS:5,922 COSTS(000):$0
Evaluating Tools for Health Promotion and Disease Prevention
FORMS: NONE
OMB NO: 0920-0686 EXPIRATION DATE: 10/31/2006
RESPS:356 HOURS:178 COSTS(000):$0
Ecology of Bats in Households: A Survey for Assessing Knowledge,
Attitudes, and Health Risks
FORMS: NONE
OMB NO: 0920-0689 EXPIRATION DATE: 08/31/2008
RESPS:199 HOURS:56 COSTS(000):$0
Factors Impacting Effective Removal of Arsenic by Household
Water Purification Systems
FORMS: NONE
OMB NO: 0920-0691 EXPIRATION DATE: 08/31/2008
RESPS:102 HOURS:26 COSTS(000):$0
State Medicaid Tobacco Coverage Survey
FORMS: NONE
OMB NO: 0920-0692 EXPIRATION DATE: 08/31/2008
RESPS:4,000 HOURS:2,000 COSTS(000):$0
A Survey of the Knowledge, Attitudes, and Practice of Medical
and Allied Health Professionals Regarding Fetal Alcohol Exposure
FORMS: NONE
OMB NO: 0920-0693 EXPIRATION DATE: 10/31/2008
RESPS:625 HOURS:646 COSTS(000):$0
Validating Autism Surveillance Methodology in Metropolitan
Atlanta Developmental Disabilities Surveillance Program (MADDSP)
FORMS: NONE
OMB NO: 0920-0694 EXPIRATION DATE: 11/30/2008
RESPS:150 HOURS:54 COSTS(000):$0
Potential Reproductive and Neurological Effects of Exposure to
Acrylamide
FORMS: NONE
OMB NO: 0920-0696 EXPIRATION DATE: 11/30/2006
RESPS:2,152 HOURS:122,172 COSTS(000):$2
HIV Prevention Program Evaluation and Monitoring System for
Health Departments and Community-Based Organizations (PEMS)
FORMS: NONE
OMB NO: 0920-0697 EXPIRATION DATE: 10/31/2007
RESPS:678 HOURS:285 COSTS(000):$0
Fire Fighter Fatality Investigation and Prevention Program
(FFFIPP)
FORMS: NONE
OMB NO: 0920-0698 EXPIRATION DATE: 11/30/2007
RESPS:50 HOURS:25 COSTS(000):$0
How Miners Modify Their Behavior in Response To Personal Dust
Monitor Information
FORMS: NONE
OMB NO: 0920-0699 EXPIRATION DATE: 11/30/2008
RESPS:6,900 HOURS:18,970 COSTS(000):$0
Collection of Assessment Information about the Centers for
Disease Control and Prevention Publications
FORMS: NONE
OMB NO: 0920-0700 EXPIRATION DATE: 11/30/2008
RESPS:56,900 HOURS:18,970 COSTS(000):$0
Collection of Assessment Information About the Centers for
Disease Control and Prevention (CDC) Publications
FORMS: NONE
OMB NO: 0920-0701 EXPIRATION DATE: 05/31/2007
RESPS:2,400 HOURS:450 COSTS(000):$0
Determination of Antineoplastic Drug Exposure in Healthcare
Workers
FORMS: NONE
OMB NO: 0920-0702 EXPIRATION DATE: 01/31/2008
RESPS:124 HOURS:101 COSTS(000):$0
Comprehensive Cancer Control: Capacity Assessment
FORMS: NONE
OMB NO: 0920-0703 EXPIRATION DATE: 12/31/2008
RESPS:1,200 HOURS:400 COSTS(000):$0
Delayed Symptoms Associated with the Convalescent Period of a
Dengue Infection
FORMS: NONE
OMB NO: 0920-0704 EXPIRATION DATE: 12/31/2006
RESPS:9,016 HOURS:940 COSTS(000):$0
Assessment of State Early Hearing Detection and Intervention
Programs (EHDI); A program Operations Evaluation
FORMS: NONE
OMB NO: 0920-0705 EXPIRATION DATE: 12/31/2006
RESPS:5,440 HOURS:382 COSTS(000):$0
Evaluation of the Poison HELP Campaign to Enhance Public
Awareness of the National Poison Toll-Free Number, Poison Center
Access, and Poison Prevention
FORMS: NONE
OMB NO: 0920-0706 EXPIRATION DATE: 12/31/2008
RESPS:49 HOURS:74 COSTS(000):$0
National Program of Cancer Registries - Annual Program
Evaluation Instrument (NPCR-APEI)
FORMS: NONE
OMB NO: 0920-0707 EXPIRATION DATE: 01/31/2008
RESPS:1,000 HOURS:250 COSTS(000):$0
2005 Lead Disclosure Rule Public Awareness Survey
FORMS: NONE
OMB NO: 0920-0708 EXPIRATION DATE: 01/31/2007
RESPS:61 HOURS:105 COSTS(000):$0
Surveys of Past HIV Prevention Technology Transfer Efforts
FORMS: NONE
OMB NO: 0920-0709 EXPIRATION DATE: 01/31/2009
RESPS:554 HOURS:935 COSTS(000):$0
Spanish-Language Folic Acid Communication Research and Creative
Production
FORMS: NONE
OMB NO: 0920-0710 EXPIRATION DATE: 01/31/2007
RESPS:150 HOURS:45 COSTS(000):$0
Health Communication Planning, Implementation, and Evaluation
for People with Disabilities
FORMS: NONE
OMB NO: 0920-0714 EXPIRATION DATE: 03/31/2009
RESPS:12,288 HOURS:3,276 COSTS(000):$0
Evaluation and Assessment of the Effectiveness of Activities
Supporting Fire Prevention and Safety
FORMS: NONE
OMB NO: 0920-0715 EXPIRATION DATE: 04/30/2009
RESPS:20 HOURS:26 COSTS(000):$0
Integrating HIV and Other Prevention Services into Reproductive
Health and Other Community Setting Program Evaluation
FORMS: NONE
OMB NO: 0920-0716 EXPIRATION DATE: 04/30/2009
RESPS:872 HOURS:846 COSTS(000):$0
Process Evaluation of the Protocol for Assessing Community
Excellence in Environmental Health (PACE EH)
FORMS: NONE
OMB NO: 0920-0718 EXPIRATION DATE: 10/31/2007
RESPS:5,600 HOURS:3,968 COSTS(000):$0
Preventive Cardiac Health Care Knowledge, Beliefs, and Behaviors
in Female Carriers of Duchenne/Becker Muscular Dystrophy
FORMS: NONE
OMB NO: 0920-0720 EXPIRATION DATE: 06/30/2007
RESPS:2,000 HOURS:1,058 COSTS(000):$0
Economic Evaluation of Walking Behavior in Sedentary Adults Age
50 Years and Older
FORMS: NONE
OMB NO: 0920-0722 EXPIRATION DATE: 05/31/2007
RESPS:34,478 HOURS:7,253 COSTS(000):$0
HoME: Household Medkit Evaluation Study
FORMS: NONE
OMB NO: 0920-0723 EXPIRATION DATE: 05/31/2009
RESPS:200 HOURS:250 COSTS(000):$0
The Continuous Miner Tramming Study Interviews
FORMS: NONE
OMB NO: 0920-0724 EXPIRATION DATE: 08/31/2008
RESPS:15,065 HOURS:1,552 COSTS(000):$0
The National Intimate Partner and Sexual Violence Survey (NISVS)
FORMS: NONE
OMB NO: 0920-0725 EXPIRATION DATE: 06/30/2007
RESPS:1 HOURS:70 COSTS(000):$0
Understanding the Community Context of the Diabetes Education in
Tribal Schools Project
FORMS: NONE
OMB NO: 0920-0726 EXPIRATION DATE: 06/30/2008
RESPS:4,250 HOURS:1,833 COSTS(000):$0
2006 Hispanic/Latino Adult Tobacco Survey
FORMS: NONE
OMB NO: 0920-0729 EXPIRATION DATE: 06/30/2009
RESPS:2,680 HOURS:547 COSTS(000):$0
Customer Surveys Generic Clearance for the National Center for
Health Statistics
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
151 5,183,861 1,324,264 $87,154
Agency for Toxic Substances and Disease Registry
OMB NO: 0923-0002 EXPIRATION DATE: 10/31/2006
RESPS:34 HOURS:17 COSTS(000):$0
Information Collection Procedures for Requesting Public Health
Assessments
FORMS: NONE
OMB NO: 0923-0006 EXPIRATION DATE: 08/31/2006
RESPS:1,667 HOURS:834 COSTS(000):$0
National Exposure Registry
FORMS: NONE
OMB NO: 0923-0007 EXPIRATION DATE: 11/30/2007
RESPS:150 HOURS:25 COSTS(000):$0
Community Assistance Panels Nomination Form
FORMS: NONE
OMB NO: 0923-0008 EXPIRATION DATE: 05/31/2008
RESPS:9,500 HOURS:6,050 COSTS(000):$0
Hazardous Substances Emergency Events Surveillance
FORMS: NONE
OMB NO: 0923-0028 EXPIRATION DATE: 02/28/2007
RESPS:4,981 HOURS:415 COSTS(000):$0
Evaluation of Customer Satisfaction with the Agency for Toxic
Substances and Disease Registry Internet Home Page and Links
FORMS: NONE
OMB NO: 0923-0035 EXPIRATION DATE: 07/31/2007
RESPS:500 HOURS:41 COSTS(000):$0
Online Evalution of a GIS Map Server Project with the Migrant
Clinicians Network
FORMS: NONE
OMB NO: 0923-0036 EXPIRATION DATE: 07/31/2007
RESPS:200 HOURS:150 COSTS(000):$0
Exposure to Volatile Organic Compounds in Drinking Water and
Specific Birth Defects and Childhood Cancers at United States
Marine Corps Base Camp Lejeune, North Carolina.
FORMS: NONE
OMB NO: 0923-0040 EXPIRATION DATE: 07/31/2009
RESPS:750 HOURS:375 COSTS(000):$0
NCEH/ATSDR Exposure Investigations (EI)
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
8 17,782 7,907 $0
National Institutes of Health
OMB NO: 0925-0001 EXPIRATION DATE: 09/30/2007
RESPS:122,000 HOURS:1,032,439 COSTS(000):$500
Research and Research Training Grant Applications and Related
Forms
FORMS: PHS-398 2590 2271 3734 HHS-568
OMB NO: 0925-0002 EXPIRATION DATE: 10/31/2008
RESPS:51,822 HOURS:124,034 COSTS(000):$18
Individual Ruth L. Kirschstein National Research Service Award
Applications and Related Forms
FORMS: 416-5 416-7 416-9 6031 6031-1 PHS-416-1
OMB NO: 0925-0046 EXPIRATION DATE: 10/31/2006
RESPS:13,780 HOURS:2,010 COSTS(000):$0
Pretesting of NCI's Office of Communications Messages
FORMS: NONE
OMB NO: 0925-0208 EXPIRATION DATE: 11/30/2006
RESPS:405,900 HOURS:1,951 COSTS(000):$0
The National Cancer Institute Cancer Information Service
Demographic Customer Service Data Collection
FORMS: NONE
OMB NO: 0925-0216 EXPIRATION DATE: 12/31/2007
RESPS:12,202 HOURS:6,886 COSTS(000):$0
The Framingham Study
FORMS: NONE
OMB NO: 0925-0240 EXPIRATION DATE: 11/30/2007
RESPS:66,339 HOURS:3,378 COSTS(000):$0
Drug Accountability Record
FORMS: NIH-2564 NIH-2564-1
OMB NO: 0925-0281 EXPIRATION DATE: 02/28/2007
RESPS:13,640 HOURS:2,319 COSTS(000):$0
The Atherosclerosis Risk in Communities Study (ARIC)
FORMS: NONE
OMB NO: 0925-0299 EXPIRATION DATE: 08/31/2006
RESPS:21,545 HOURS:11,369 COSTS(000):$0
NIH Intramural Research Training Award Program Application
FORMS: NONE
OMB NO: 0925-0334 EXPIRATION DATE: 09/30/2007
RESPS:12,582 HOURS:868 COSTS(000):$0
The Cardiovascular, Heart Diseases Health Study
FORMS: NONE
OMB NO: 0925-0348 EXPIRATION DATE: 08/31/2006
RESPS:36 HOURS:360 COSTS(000):$0
Hazardous Waste Worker Training
FORMS: NONE
OMB NO: 0925-0361 EXPIRATION DATE: 06/30/2008
RESPS:12,468 HOURS:29,038 COSTS(000):$0
National Institutes of Health Loan Repayment Programs
FORMS: 2674-1-NO.7 2674-7 2674-2-NO.8 2674-8 2674-3-NO.9 2674-9
2674-4-NO.10 2674-10 2674-5-NO.11 2674-11
OMB NO: 0925-0368 EXPIRATION DATE: 04/30/2009
RESPS:95,000 HOURS:11,106 COSTS(000):$0
American Stop Smoking Intervention Study for Cancer Prevention
Final Eval.: "Tobacco Use Supplement to the 1998-99 Current
Population Survey"
FORMS: NONE
OMB NO: 0925-0378 EXPIRATION DATE: 08/31/2007
RESPS:200 HOURS:114 COSTS(000):$0
Application for the Pharmacology Research Associate Program
FORMS: NIH-2721-1 NIH-2721-2
OMB NO: 0925-0405 EXPIRATION DATE: 02/28/2007
RESPS:59,200 HOURS:29,500 COSTS(000):$0
Generic Clearance to Collect Medical Outcome and Risk Factor
Data from a Cohort of U.S. Radiologic Technologists
FORMS: NONE
OMB NO: 0925-0406 EXPIRATION DATE: 10/31/2008
RESPS:24,733 HOURS:44,270 COSTS(000):$0
Agricultural Health Study (A Prospective Cohort Study of Cancer
and Other Diseases Among Men and Women in Agriculture
FORMS: NONE
OMB NO: 0925-0407 EXPIRATION DATE: 10/31/2008
RESPS:1 HOURS:23,086 COSTS(000):$0
Prostate, Lung, Colorectal and Overian (PLCO) Cancer Screening
Trial
FORMS: NONE
OMB NO: 0925-0414 EXPIRATION DATE: 05/31/2009
RESPS:88,131 HOURS:18,319 COSTS(000):$0
Women's Health Initiative Observational Study
FORMS: NONE
OMB NO: 0925-0417 EXPIRATION DATE: 11/30/2008
RESPS:42,800 HOURS:232,000 COSTS(000):$4
Responsibility of Applicants for Promoting Objectivity in
Reserch for which Public Health Service Funding is Sought
FORMS: NONE
OMB NO: 0925-0424 EXPIRATION DATE: 08/31/2008
RESPS:16,481 HOURS:16,481 COSTS(000):$0
National Institutes of Health Construction Grants
FORMS: NONE
OMB NO: 0925-0438 EXPIRATION DATE: 12/31/2007
RESPS:1,580 HOURS:2,033 COSTS(000):$0
National Institutes of Health Undergraduate Scholarship Program
for Individuals from Disadvantaged Backgrounds
FORMS: NIH-2762-1 NIH-2762-2 NIH-2762-3 NIH-2762-4 NIH-2762-5
OMB NO: 0925-0454 EXPIRATION DATE: 01/31/2008
RESPS:862 HOURS:396 COSTS(000):$0
Case-Cohort Study of Cancer and Related Disorders Among
Benzene-Exposed Workers in China
FORMS: NONE
OMB NO: 0925-0458 EXPIRATION DATE: 06/30/2007
RESPS:2,965 HOURS:2,671 COSTS(000):$0
Satisfaction Surveys of Customers and Other Partners
FORMS: NONE
OMB NO: 0925-0465 EXPIRATION DATE: 10/31/2006
RESPS:2,441 HOURS:814 COSTS(000):$0
Re-contacting Participants in the Observing Protein and Energy
Nutrition (Re-OPEN) Study
FORMS: NONE
OMB NO: 0925-0474 EXPIRATION DATE: 09/30/2007
RESPS:2,100 HOURS:693 COSTS(000):$0
Generic Clearance for Satisfaction Surveys of Customers
FORMS: NONE
OMB NO: 0925-0475 EXPIRATION DATE: 11/30/2008
RESPS:400 HOURS:148 COSTS(000):$0
Training Tomorrow's Scientists: Linking Minorities and Mentors
Through the Web
FORMS: NONE
OMB NO: 0925-0476 EXPIRATION DATE: 07/31/2009
RESPS:19,758 HOURS:2,680 COSTS(000):$0
Request for Generic Clearance to Conduct Voluntary
Customer/Partner Surveys
FORMS: NONE
OMB NO: 0925-0479 EXPIRATION DATE: 09/30/2006
RESPS:51 HOURS:18 COSTS(000):$0
Request for Clearance to Conduct Voluntary Customer Satisfaction
Surveys
FORMS: NONE
OMB NO: 0925-0480 EXPIRATION DATE: 11/30/2006
RESPS:12,000 HOURS:2,000 COSTS(000):$0
NIDDK Information Clearinghouse Customer Satisfaction Survey
FORMS: NONE
OMB NO: 0925-0483 EXPIRATION DATE: 06/30/2009
RESPS:733 HOURS:122 COSTS(000):$0
Environmental Factors in the Development of Polycystic Ovary
Syndrome
FORMS: NONE
OMB NO: 0925-0484 EXPIRATION DATE: 02/28/2007
RESPS:43,093 HOURS:43,093 COSTS(000):$0
Wave 2 National Epidemiologic Survey on Alcohol and Related
Conditions (NESARC)
FORMS: NONE
OMB NO: 0925-0486 EXPIRATION DATE: 05/31/2007
RESPS:104,000 HOURS:8,684 COSTS(000):$0
Evaluation of User Satisfaction with NIH Internet Sites
FORMS: NONE
OMB NO: 0925-0491 EXPIRATION DATE: 05/31/2007
RESPS:600 HOURS:300 COSTS(000):$0
The Jackson Heart Study: Annual Follow-up with Third Party
Respondents
FORMS: NONE
OMB NO: 0925-0493 EXPIRATION DATE: 10/31/2007
RESPS:555 HOURS:42 COSTS(000):$0
The Multi-Ethnic Study of Atherosclerosis (MESA)
FORMS: NONE
OMB NO: 0925-0501 EXPIRATION DATE: 11/30/2007
RESPS:3,030 HOURS:1,060 COSTS(000):$0
Graduate Student Training Programs Application
FORMS: NONE
OMB NO: 0925-0503 EXPIRATION DATE: 12/31/2008
RESPS:500 HOURS:500 COSTS(000):$0
Assessment of the Use of Special Funding for Research on Type 1
Diabetes
FORMS: NONE
OMB NO: 0925-0520 EXPIRATION DATE: 08/31/2006
RESPS:4,882 HOURS:387 COSTS(000):$0
National Center for Complementary and Alternative Medicine
(NCCAM) Customer Service Data Collection
FORMS: NONE
OMB NO: 0925-0522 EXPIRATION DATE: 08/31/2006
RESPS:67,527 HOURS:63,438 COSTS(000):$0
The Sister Study: Environmental and Genetic Risk Factors for
Breast Cancer
FORMS: NONE
OMB NO: 0925-0523 EXPIRATION DATE: 09/30/2006
RESPS:2 HOURS:2,887 COSTS(000):$0
Aggression Prevention Among High-Risk Early Adolescents
FORMS: NONE
OMB NO: 0925-0524 EXPIRATION DATE: 11/30/2006
RESPS:986 HOURS:441 COSTS(000):$0
Assessment for Minority Research Training Programs
FORMS: NONE
OMB NO: 0925-0525 EXPIRATION DATE: 12/31/2006
RESPS:8,602 HOURS:3,267 COSTS(000):$0
Effectiveness of the National Institute on Drug Abuse's
Publications Project
FORMS: NONE
OMB NO: 0925-0526 EXPIRATION DATE: 02/28/2007
RESPS:7,642 HOURS:910 COSTS(000):$0
Customer Satisfaction with Educational Programs and Products of
the National Cancer Institute
FORMS: NONE
OMB NO: 0925-0527 EXPIRATION DATE: 06/30/2007
RESPS:750 HOURS:248 COSTS(000):$0
Career Survey of Biomedical Researchers
FORMS: NONE
OMB NO: 0925-0528 EXPIRATION DATE: 07/31/2007
RESPS:500 HOURS:184 COSTS(000):$0
Physicians' Experience of Ethical Dilemmas and Resource
Allocation
FORMS: NONE
OMB NO: 0925-0530 EXPIRATION DATE: 06/30/2007
RESPS:2,440 HOURS:712 COSTS(000):$0
National Center for Complementary and Alternative Medicine
(NCCAM) Communications Program Planning and Evaluation
FORMS: NONE
OMB NO: 0925-0531 EXPIRATION DATE: 09/30/2007
RESPS:1,072 HOURS:1,072 COSTS(000):$0
The Impact of A Decade of the Fogarty International Research
Collaboration Award (FIRCA)
FORMS: NONE
OMB NO: 0925-0532 EXPIRATION DATE: 10/31/2007
RESPS:13,625 HOURS:1,872 COSTS(000):$0
NICHD Research Partner Satisfaction Surveys
FORMS: NONE
OMB NO: 0925-0534 EXPIRATION DATE: 08/31/2007
RESPS:3,500 HOURS:1,200 COSTS(000):$0
NIH Customer/Partner Satisfaction Survey of Modification in
Procedures for Applications and Awards of Research Project Grants
FORMS: NONE
OMB NO: 0925-0535 EXPIRATION DATE: 11/30/2007
RESPS:1,875 HOURS:625 COSTS(000):$0
Obstetrician-Gynecologists' Knowledge and Practice Patterns with
Regard to Hormone Therapy
FORMS: NONE
OMB NO: 0925-0536 EXPIRATION DATE: 09/30/2007
RESPS:185 HOURS:157 COSTS(000):$0
Career Survey of Science-Oriented Scholars
FORMS: NONE
OMB NO: 0925-0538 EXPIRATION DATE: 11/30/2007
RESPS:10,489 HOURS:4,036 COSTS(000):$0
Health Information National Trends Survey II (HINTS)
FORMS: NONE
OMB NO: 0925-0540 EXPIRATION DATE: 12/31/2007
RESPS:2,568 HOURS:759 COSTS(000):$0
Pilot Study Evaluating the Cross-Cultural Equivalency of the
Tobacco Use Supplement to the Current Population Survey
FORMS: NONE
OMB NO: 0925-0541 EXPIRATION DATE: 12/31/2007
RESPS:600 HOURS:150 COSTS(000):$0
Improving Media Coverage of Cancer: A Survey of Science and
Health Reporters
FORMS: NONE
OMB NO: 0925-0542 EXPIRATION DATE: 04/30/2008
RESPS:479 HOURS:434 COSTS(000):$0
Brain Power! The NIDA Junior Scientist Program and the Companion
Program, Brain Power! Challenge
FORMS: NONE
OMB NO: 0925-0543 EXPIRATION DATE: 03/31/2008
RESPS:1,000 HOURS:15,380 COSTS(000):$0
Longitudinal Investigation of Fertility and the Environment
FORMS: NONE
OMB NO: 0925-0547 EXPIRATION DATE: 06/30/2008
RESPS:80 HOURS:40 COSTS(000):$0
Outcome Evaluation of the Small Grants Program Research in
Cancer Control
FORMS: NONE
OMB NO: 0925-0548 EXPIRATION DATE: 06/30/2008
RESPS:400 HOURS:132 COSTS(000):$0
Survey of Colorectal Cancer Screening Policies, Programs and
Systems in U.S. Health Plans
FORMS: NONE
OMB NO: 0925-0549 EXPIRATION DATE: 09/30/2008
RESPS:1 HOURS:88 COSTS(000):$0
Evaluation of NCI's Central Institutional Review Board to
Improve Cancer Clinical Trials System.
FORMS: NONE
OMB NO: 0925-0550 EXPIRATION DATE: 07/31/2008
RESPS:275 HOURS:706 COSTS(000):$0
Inventory and Evaluation of Clinical Research Networks
FORMS: NONE
OMB NO: 0925-0551 EXPIRATION DATE: 11/30/2008
RESPS:11,735 HOURS:1,155 COSTS(000):$0
The Effectiveness of the NIH Curriculum Supplements Programs
FORMS: NONE
OMB NO: 0925-0552 EXPIRATION DATE: 11/30/2008
RESPS:1 HOURS:400 COSTS(000):$0
National Diabetes Education Program Evaluation Survey of the
Public
FORMS: NONE
OMB NO: 0925-0554 EXPIRATION DATE: 12/31/2008
RESPS:150 HOURS:50 COSTS(000):$0
Survey of Institutional Program Directors of NIGMS MORE Programs
FORMS: NONE
OMB NO: 0925-0557 EXPIRATION DATE: 01/31/2009
RESPS:14,790 HOURS:10,875 COSTS(000):$0
Health Behaviors in School-Age Children Survey
FORMS: NONE
OMB NO: 0925-0558 EXPIRATION DATE: 04/30/2009
RESPS:1,060 HOURS:662 COSTS(000):$0
Discovering the Science of Alcohol Program Field Test Data
Collection Instruments
FORMS: NONE
OMB NO: 0925-0560 EXPIRATION DATE: 03/31/2009
RESPS:5,475 HOURS:2,300 COSTS(000):$0
5 A Day Customized Survey
FORMS: NONE
OMB NO: 0925-0561 EXPIRATION DATE: 05/31/2009
RESPS:450 HOURS:756 COSTS(000):$0
Use of In-Home Test Kits in Dust Mite Allergen Reduction
FORMS: NONE
OMB NO: 0925-0562 EXPIRATION DATE: 07/31/2009
RESPS:2,500 HOURS:835 COSTS(000):$0
National Survey of Primary Care Physicians for Breast, Cervical,
Colorectal, and Lung Cancer Screening
FORMS: NONE
OMB NO: 0925-0564 EXPIRATION DATE: 07/31/2009
RESPS:1,268 HOURS:480 COSTS(000):$0
Brain Train 4 Kids
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
67 1,420,437 1,771,420 $522
Substance Abuse and Mental Health Services Administration
OMB NO: 0930-0074 EXPIRATION DATE: 04/30/2007
RESPS:79 HOURS:14 COSTS(000):$0
Obligated Service for Mental Health Traineeships: Regulations
and Forms
FORMS: SMA-111-2
OMB NO: 0930-0078 EXPIRATION DATE: 12/31/2008
RESPS:26,829 HOURS:111,938 COSTS(000):$0
Drug Abuse Warning Network (DAWN)
FORMS: NONE
OMB NO: 0930-0080 EXPIRATION DATE: 08/31/2007
RESPS:60 HOURS:31,880 COSTS(000):$0
Substance Abuse Prevention and Treatment Block Grant (SAPTBG)
Regulations (45 CFR Part 96) and FY 2005-2007 Application Format
FORMS: NONE
OMB NO: 0930-0092 EXPIRATION DATE: 08/31/2007
RESPS:1,760,526 HOURS:353,349 COSTS(000):$87
Confidentiality of Alcohol and Drug Abuse Patient Records - 42
CFR Part 2
FORMS: NONE
OMB NO: 0930-0093 EXPIRATION DATE: 11/30/2006
RESPS:52 HOURS:38 COSTS(000):$0
Annual Census of Patient Characteristics in State and County
Mental Hospital Inpatient Services
FORMS: SMA-102
OMB NO: 0930-0104 EXPIRATION DATE: 09/30/2007
RESPS:5 HOURS:3 COSTS(000):$0
Community Mental Health Centers Construction Grantee Checklist
Form and Regulations
FORMS: SMA-101
OMB NO: 0930-0106 EXPIRATION DATE: 11/30/2008
RESPS:23,125 HOURS:6,491 COSTS(000):$0
Drug and Alcohol Services Information System
FORMS: NONE
OMB NO: 0930-0110 EXPIRATION DATE: 01/31/2007
RESPS:182,250 HOURS:86,877 COSTS(000):$0
2006 National Survey on Drug Use and Health (NSDUH)
FORMS: NONE
OMB NO: 0930-0119 EXPIRATION DATE: 07/31/2008
RESPS:9,690 HOURS:14,463 COSTS(000):$0
2004 Inventory of Mental Health Organizations, and General
Hospital Mental Health Services, and Managed Care Organizations
Survey (IMHO)
FORMS: NONE
OMB NO: 0930-0158 EXPIRATION DATE: 08/31/2006
RESPS:28,384,168 HOURS:1,788,089 COSTS(000):$2,071
Mandatory Guidelines for Federal Workplace Drug Testing Program
FORMS: NONE
OMB NO: 0930-0163 EXPIRATION DATE: 04/30/2007
RESPS:60 HOURS:960 COSTS(000):$0
Substance Abuse Prevention and Treatment Block Grant Reguations
- 45 CFR Part 96
FORMS: NONE
OMB NO: 0930-0168 EXPIRATION DATE: 07/31/2007
RESPS:59 HOURS:17,265 COSTS(000):$0
Community Mental Health Services Block Grant Application
Guidance and Instructions, FY 2005-2007
FORMS: NONE
OMB NO: 0930-0169 EXPIRATION DATE: 05/31/2007
RESPS:114 HOURS:2,166 COSTS(000):$0
Protection and Advoccy of Individuals With Mental Illness
(PAIMI) Annual Program Performance Report
FORMS: NONE
OMB NO: 0930-0172 EXPIRATION DATE: 02/28/2007
RESPS:142 HOURS:184 COSTS(000):$0
Protection and Advocacy for Individuals with Mental Illness
Regulations -- 45 CFR Part 51
FORMS: NONE
OMB NO: 0930-0195 EXPIRATION DATE: 11/30/2007
RESPS:12,600 HOURS:1,843 COSTS(000):$0
Participant Feedback Forms for the Mental Health Care Provider
Education (MHCPE) in the HIV/AIDS Program
FORMS: NONE
OMB NO: 0930-0196 EXPIRATION DATE: 06/30/2007
RESPS:11,700 HOURS:9,290 COSTS(000):$0
Pretesting of Substance Abuse Prevention and Treatment and
Mental Health Services Communications Messages
FORMS: NONE
OMB NO: 0930-0197 EXPIRATION DATE: 12/31/2007
RESPS:30,150 HOURS:15,225 COSTS(000):$0
Voluntary Customer Satisfaction Surveys to Implement Executive
Order 12862 in the Substance Abuse and Mental Health Services
Administration (SAMHSA)
FORMS: NONE
OMB NO: 0930-0205 EXPIRATION DATE: 07/31/2009
RESPS:506 HOURS:14,398 COSTS(000):$0
Annual Reports for Projects for Assistance in Transition from
Homelessness (PATH)
FORMS: NONE
OMB NO: 0930-0206 EXPIRATION DATE: 09/30/2006
RESPS:9,677 HOURS:2,035 COSTS(000):$2,524
Opioid Drugs in Maintenance and Detoxification Treatment of
Opiate Addiction - 42 CFR Part 8
FORMS: SMA-162 SMA-163 SMA-168
OMB NO: 0930-0208 EXPIRATION DATE: 01/31/2007
RESPS:337,810 HOURS:24,960 COSTS(000):$0
Government Performance and Results Act Client/Participant
Outcome Measures
FORMS: NONE
OMB NO: 0930-0209 EXPIRATION DATE: 11/30/2006
RESPS:76,431 HOURS:14,040 COSTS(000):$0
National Evaluation of the Comprehensive Community Mental Health
Services for Children and Their Families Program: Phase Three
FORMS: NONE
OMB NO: 0930-0216 EXPIRATION DATE: 10/31/2006
RESPS:23,260 HOURS:7,010 COSTS(000):$0
National Cross-Site Assessment of Addiction Technology Transfer
Centers (ATTC) Network
FORMS: NONE
OMB NO: 0930-0222 EXPIRATION DATE: 08/31/2007
RESPS:59 HOURS:1,062 COSTS(000):$0
Substance Abuse Prevention and Treatment Block Grant Synar
Report Format, FY 2005-2007
FORMS: NONE
OMB NO: 0930-0226 EXPIRATION DATE: 11/30/2007
RESPS:1,446 HOURS:8,151 COSTS(000):$0
Protocols for the Cross-Site Process Evaluation of the State
incentive Grant (SIG) Program
FORMS: NONE
OMB NO: 0930-0229 EXPIRATION DATE: 07/31/2008
RESPS:6 HOURS:18 COSTS(000):$0
Emergency Response Grants - 42 CFR Part 51
FORMS: NONE
OMB NO: 0930-0230 EXPIRATION DATE: 12/31/2008
RESPS:246 HOURS:419 COSTS(000):$0
National Outcome Measures for Substance Abuse Prevention
FORMS: NONE
OMB NO: 0930-0232 EXPIRATION DATE: 03/31/2008
RESPS:3,120 HOURS:780 COSTS(000):$0
Workplace Helpline Call Record Form
FORMS: NONE
OMB NO: 0930-0234 EXPIRATION DATE: 03/31/2009
RESPS:2,050 HOURS:135 COSTS(000):$0
Notification of Intent to Use Schedule III, IV, or V Opioid
Drugs for the Maintenance and Detoxification Treatment of Opiate
Addiction
FORMS: NONE
OMB NO: 0930-0242 EXPIRATION DATE: 09/30/2006
RESPS:319,906 HOURS:16,208 COSTS(000):$56
Regulations to Implement SAMHSA's Charitable Choice Statutory
Provisions: 42 CFR Parts 54 and 54a
FORMS: SMA-170
OMB NO: 0930-0248 EXPIRATION DATE: 10/31/2006
RESPS:789 HOURS:1,123 COSTS(000):$0
Evaluation of Program Rehabilitation and Restitution (PRR)
FORMS: NONE
OMB NO: 0930-0249 EXPIRATION DATE: 10/31/2006
RESPS:1,788 HOURS:928 COSTS(000):$0
Family Treatment Drug Court Evaluation
FORMS: NONE
OMB NO: 0930-0252 EXPIRATION DATE: 12/31/2006
RESPS:106 HOURS:53 COSTS(000):$0
Safe Schools/Healthy Students Sustainability Study
FORMS: NONE
OMB NO: 0930-0255 EXPIRATION DATE: 08/31/2007
RESPS:500 HOURS:750 COSTS(000):$0
SAMHSA Application for Peer Grant Reviewers
FORMS: NONE
OMB NO: 0930-0257 EXPIRATION DATE: 04/30/2007
RESPS:51,293 HOURS:25,262 COSTS(000):$0
National Evaluation of the Comprehensive Community Mental Health
Services for Children and Their Families Program: Phase Four
FORMS: NONE
OMB NO: 0930-0258 EXPIRATION DATE: 11/30/2007
RESPS:2,000 HOURS:334 COSTS(000):$0
Assessment of the Reach Out Now! Teach-In Initiative
FORMS: NONE
OMB NO: 0930-0261 EXPIRATION DATE: 10/31/2007
RESPS:7,354 HOURS:4,886 COSTS(000):$0
National Surey on Drug Use and Health_ Methodological Field Tests
FORMS: NONE
OMB NO: 0930-0262 EXPIRATION DATE: 11/30/2007
RESPS:1,833 HOURS:770 COSTS(000):$0
Evaluation of Buprenorphine Waiver Program: Waivered Physicians
Survey
FORMS: NONE
OMB NO: 0930-0265 EXPIRATION DATE: 05/31/2008
RESPS:51 HOURS:51 COSTS(000):$0
Survey of Medicaid Directors Regarding Medicaid Mental Health
Services and Policy
FORMS: NONE
OMB NO: 0930-0266 EXPIRATION DATE: 05/31/2008
RESPS:398,226 HOURS:81,318 COSTS(000):$0
Access to Recovery (ATR) Program
FORMS: NONE
OMB NO: 0930-0269 EXPIRATION DATE: 09/30/2007
RESPS:1,338 HOURS:335 COSTS(000):$0
Cross-Site Accountability Assessment of the Residential
Treatment for Prgnant and Postpartum Women and Their Minor
Children Program (PPW)
FORMS: NONE
OMB NO: 0930-0270 EXPIRATION DATE: 09/30/2008
RESPS:16,700 HOURS:741 COSTS(000):$0
Toolkit Protocol for the Crisis Counseling Assistance and
Training Program (CCP)
FORMS: NONE
OMB NO: 0930-0271 EXPIRATION DATE: 11/30/2008
RESPS:1,274 HOURS:9,702 COSTS(000):$0
Initiative to Reduce/Eliminate Seclusion and Restraint: 8 State
Incentive Grants and Coordinating Center
FORMS: NONE
OMB NO: 0930-0272 EXPIRATION DATE: 12/31/2008
RESPS:60 HOURS:60 COSTS(000):$0
Survey of Single State Authorities Regarding the HIV Set-Aside
of the Substance Abuse Prevention and Treatment Block Grant
FORMS: NONE
OMB NO: 0930-0274 EXPIRATION DATE: 02/28/2009
RESPS:366 HOURS:264 COSTS(000):$0
Monitoring of National Suicide Prevention Lifeline Form
FORMS: NONE
OMB NO: 0930-0275 EXPIRATION DATE: 02/28/2009
RESPS:720 HOURS:598 COSTS(000):$0
Evaluation of Networking Suicide Prevention Hotlines Followup
Assessment
FORMS: NONE
OMB NO: 0930-0276 EXPIRATION DATE: 04/30/2009
RESPS:24 HOURS:11,322 COSTS(000):$0
Cross-Site Evaluation of the National Child Traumatic Stress
Initiative (NCTSI)
FORMS: NONE
OMB NO: 0930-0277 EXPIRATION DATE: 05/31/2009
RESPS:26,894 HOURS:1,373 COSTS(000):$0
Targeted Capacity Expansion Grants for Jail Diversion Programs
FORMS: NONE
OMB NO: 0930-0278 EXPIRATION DATE: 07/31/2009
RESPS:430 HOURS:724 COSTS(000):$0
Evaluation of the Policy Academies on Chronic Homelessness
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
48 31,727,872 2,669,885 $4,738
Agency for Health Care Research and Quality
OMB NO: 0935-0106 EXPIRATION DATE: 01/31/2008
RESPS:103,400 HOURS:16,356 COSTS(000):$515,732
Voluntary Customer Surveys Generic Clearance for the Agency for
Healthcare Research and Quality
FORMS: NONE
OMB NO: 0935-0110 EXPIRATION DATE: 02/29/2008
RESPS:36,264 HOURS:20,922 COSTS(000):$0
2004 - 2006 Medical Expenditure Panel Survey - Insurance
Componenet (MEPS-IC)
FORMS: NONE
OMB NO: 0935-0117 EXPIRATION DATE: 02/28/2007
RESPS:285 HOURS:87 COSTS(000):$0
Surveys of Employee Benefit Managers of Large National Employers
Concerning Dissemination Effectiveness of Health Services
Research Information
FORMS: NONE
OMB NO: 0935-0118 EXPIRATION DATE: 02/28/2007
RESPS:83,700 HOURS:249,848 COSTS(000):$0
Medical Expenditure Panel Survey Household Component and Medical
Provider Component (MEPS-HC and MEPS-MPC 2004 and 2005)
FORMS: NONE
OMB NO: 0935-0122 EXPIRATION DATE: 11/30/2007
RESPS:1,500 HOURS:250 COSTS(000):$0
AHRQ Grants Reporting System
FORMS: NONE
OMB NO: 0935-0124 EXPIRATION DATE: 01/31/2008
RESPS:10,500 HOURS:5,200 COSTS(000):$0
Questionnaire and Data Collection Testing, Evaluation, and
Research for the Agency for Healthcare Research and Quality
FORMS: NONE
OMB NO: 0935-0125 EXPIRATION DATE: 07/31/2008
RESPS:960 HOURS:403 COSTS(000):$0
National Study of the Hospital Adverse Event Reporting Survey
FORMS: NONE
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
7 236,609 293,066 $515,732
Office of Assistant Secretary for Health
OMB NO: 0937-0025 EXPIRATION DATE: 09/30/2006
RESPS:10,000 HOURS:4,000 COSTS(000):$0
Reference Request for Applicants to the U.S. Public Health
Service Commissioned Corps
FORMS: PHS-50 PHS-1813
OMB NO: 0937-0166 EXPIRATION DATE: 08/31/2006
RESPS:50,000 HOURS:50,000 COSTS(000):$0
42 C.F.R. Subpart B: Sterilization of Persons in Federally
Assisted Family Planning Projects
FORMS: NONE
OMB NO: 0937-0191 EXPIRATION DATE: 02/29/2008
RESPS:22 HOURS:4,400 COSTS(000):$0
Application Packets for Real Property for Public Health Purposes
FORMS: HHS-696
OMB NO: 0937-0198 EXPIRATION DATE: 03/31/2009
RESPS:3,800 HOURS:400 COSTS(000):$0
Public Health Service Policies on Research Misconduct (42 CFR
Part 93)
FORMS: PHS-6349
OMB NO: 0937-0200 EXPIRATION DATE: 06/30/2007
RESPS:73,560 HOURS:220,980 COSTS(000):$0
HHS Payment Management System Forms PMS-270 - Request for
Advance or Reimbursement and PMS-272 - Federal Cast Transaction
Report
FORMS: 270 272
SUBAGENCY TOTALS
ACTIVE ANNUAL ANNUAL ANNUAL
REPORTS RESPONSES HOURS COSTS($000)
5 137,382 279,780 $0
Centers for Medicare and Medicaid Services
OMB NO: 0938-0008 EXPIRATION DATE: 05/31/2009
RESPS:957,204,707 HOURS:46,383,364 COSTS(000):$0
Health Insurance Common Claims Form and Supporting Regulations
at 42 CFR Part 424, Subpart C
FORMS: CMS-1490S CMS-1490U CMS-1500(12-90)
OMB NO: 0938-0022 EXPIRATION DATE: 04/30/2007
RESPS:7,310 HOURS:1,311,060 COSTS(000):$0
Home Health Agency Cost Report and Supporting Regulations in 42
CFR 413.20, 413.24, 413.106
FORMS: CMS-1728-94
OMB NO: 0938-0023 EXPIRATION DATE: 07/31/2008
RESPS:200 HOURS:50 COSTS(000):$0
Attending Physicians Statement and Documentation of Medicare
Emergency and Supporting Regulations in 42 CFR 424.103
FORMS: CMS-1771
OMB NO: 0938-0025 EXPIRATION DATE: 08/31/2006
RESPS:14,000 HOURS:5,833 COSTS(000):$0
Request for Termination of Premium-Hospital and/or Supplementary
Medical Insurance and Supporting Regulations in 42 CFR 406.28 &
407.27
FORMS: CMS-1763
OMB NO: 0938-0027 EXPIRATION DATE: 02/28/2009
RESPS:98 HOURS:172 COSTS(000):$0
Request for Certification as Supplier of Portable X-Ray and
Portable X-Ray Survey Report Form
FORMS: 1880-1882
OMB NO: 0938-0033 EXPIRATION DATE: 05/31/2007
RESPS:6,860,000 HOURS:1,629,000 COSTS(000):$0
Request for Review of Part B Medicare Claim and Supporting
Regulations in 42 CFR Sec. 405.807
FORMS: CMS-1964
OMB NO: 0938-0035 EXPIRATION DATE: 07/31/2009
RESPS:6,600 HOURS:2,366 COSTS(000):$0
Social Security Office (SSO) Report of State Buy-in Problems
FORMS: CMS-1957
OMB NO: 0938-0037 EXPIRATION DATE: 01/31/2008
RESPS:618 HOURS:61,800 COSTS(000):$0
Outpatient Rehabilitation Cost Report and Supporting Regulations
in 42 CFR 413.20 and 413.24
FORMS: CMS-2088-92
OMB NO: 0938-0041 EXPIRATION DATE: 11/30/2006
RESPS:17,350 HOURS:6,446 COSTS(000):$0
Third Party Premium Billing Request and Supporting Regulations
in 42 CFR 408.6 and 408.202
FORMS: CMS-2384
OMB NO: 0938-0042 EXPIRATION DATE: 04/30/2007
RESPS:240,000 HOURS:60,010 COSTS(000):$0
Request for Medicare Payment -- Ambulance and Supporting
Regulations in 42 CFR Sections 410.1, 410.40, 424.124, 424.601,
414.605, 414.610, 414.615, 414.620, 414.625, and 424.32
FORMS: CMS-1491
OMB NO: 0938-0045 EXPIRATION DATE: 11/30/2006
RESPS:60,000 HOURS:15,000 COSTS(000):$0
Request for Reconsideration of Part A Medicare Claim and
Supporting Regulations in 42 CFR, 405.711
FORMS: CMS-2649
OMB NO: 0938-0046 EXPIRATION DATE: 06/30/2007
RESPS:100,000 HOURS:75,000 COSTS(000):$0
End Stage Renal Disease Medical Evidence Report Medicare
Entitlement and/or Patient Registration and Supporting
Regulations in 42 CFR, 405.2133; PL 95-292; CFR Parts....
FORMS: CMS-2728-ESRD
OMB NO: 0938-0050 EXPIRATION DATE: 05/31/2008
RESPS:6,111 HOURS:4,046,782 COSTS(000):$0
Hospitals and Health Care Complex Cost Report
FORMS: 2552-96
OMB NO: 0938-0062 EXPIRATION DATE: 01/31/2007
RESPS:177,271,815 HOURS:6,841,538 COSTS(000):$0
Intermediate Care Facility for the Mentally Retarded or Persons
with Related Conditions ICF/MR Survey Report Form (3070G-I) and
Supporting Regulations at 42CFR 442.30, 483.410, 483.420,...
FORMS: CMS-3070G-I
OMB NO: 0938-0065 EXPIRATION DATE: 10/31/2008
RESPS:495 HOURS:866 COSTS(000):$0
Outpatient Physical Therapy Speech Pathology Survey Report and
Supporting Regulation in 42 CFR 485.701-485.729
FORMS: 1856 1893
OMB NO: 0938-0067 EXPIRATION DATE: 06/30/2008
RESPS:224 HOURS:18,144 COSTS(000):$0
Quarterly Medicaid Statement of Expenditures for the Medical
Assistance Program
FORMS: CMS-64
OMB NO: 0938-0074 EXPIRATION DATE: 12/31/2008
RESPS:698 HOURS:1,222 COSTS(000):$0
Request for Certification as Rural Health Clinic and Rural
Health Clinic Survey Report Form and Supporting Regulations in
42 CFR 491.1-491.11
FORMS: 0029-0030
OMB NO: 0938-0080 EXPIRATION DATE: 10/31/2006
RESPS:60,000 HOURS:26,000 COSTS(000):$0
Application for Health Insurance Benefits Under Medicare for
Individual with Chronic Renal Disease and Supporting Regulations
in 42 CFR 406.7 and .13
FORMS: CMS-43
OMB NO: 0938-0086 EXPIRATION DATE: 12/31/2008
RESPS:125,000 HOURS:62,500 COSTS(000):$0
Disclosure of Ownership and Financial Control Interest Statement
and Supporting Regulations Contained in 42 CFR 420.200-.206 and
455.100-.106
FORMS: CMS-1513
OMB NO: 0938-0101 EXPIRATION DATE: 09/30/2008
RESPS:224 HOURS:7,616 COSTS(000):$0
Medicaid Program Budget Report, and Supporting Regs.
FORMS: CMS-37
OMB NO: 0938-0102 EXPIRATION DATE: 08/31/2006
RESPS:108 HOURS:4,860 COSTS(000):$0
Organ Procurement Organization/Histcompatibility Laboratory
Statement of Reimbursable Costs, Manual Instructions and
Supporting Regulations Contained in 42 CFR 413.20 and 413.24
FORMS: CMS-216
OMB NO: 0938-0107 EXPIRATION DATE: 06/30/2008
RESPS:3,000 HOURS:150,000 COSTS(000):$0
Independent Rural Health Center/Freestanding Federally Qualified
Health Center Cost Report and Supp. Regs in 42 CFR Sections
413.20 and 413.24
FORMS: CMS-222
OMB NO: 0938-0146 EXPIRATION DATE: 09/30/2006
RESPS:110 HOURS:2,640 COSTS(000):$0
State Medicaid Eligibility Quality Control Samplling Plan and
Supporting Regulations in 42 CFR 431.800 - 431.865
FORMS: CMS-317
OMB NO: 0938-0147 EXPIRATION DATE: 09/30/2006
RESPS:12 HOURS:5,280 COSTS(000):$0
State Medicaid Eligibility Control (MEQC) Sample Selection Lists
and Supporting Regulations at 42 CFR 431.800 431.865
FORMS: CMS-319
OMB NO: 0938-0151 EXPIRATION DATE: 08/31/2008
RESPS:10,500 HOURS:5,250 COSTS(000):$0
Laboratory Personnel Report (CLIA) and Supporting Regulations in
42 CFR 493.1 - 493.2001
FORMS: CMS-209
OMB NO: 0938-0155 EXPIRATION DATE: 03/31/2007
RESPS:14 HOURS:476 COSTS(000):$0
Municipal Health Services Cost Report Form and Supporting
Regulations 42 CFR 405.2470
FORMS: CMS-255
OMB NO: 0938-0165 EXPIRATION DATE: 08/31/2006
RESPS:225 HOURS:7,860 COSTS(000):$0
Prepaid Health Plan Cost Report
FORMS: CMS-276
OMB NO: 0938-0193 EXPIRATION DATE: 07/31/2007
RESPS:56 HOURS:560 COSTS(000):$0
Transmittal and Notice of Approval of State Plan Material and
Supporting Regulations in 42 CFR 430.10-430.20 and 440.167
FORMS: CMS-179
OMB NO: 0938-0202 EXPIRATION DATE: 07/31/2008
RESPS:1,231 HOURS:573,646 COSTS(000):$0
Home Office Cost Statement and Supporting Regulations in 42 CFR
413.17 and 413.20
FORMS: 287
OMB NO: 0938-0214 EXPIRATION DATE: 05/31/2009
RESPS:124,553,682 HOURS:1,611,303 COSTS(000):$0
Medicare Secondary Payer Informaiton Collection and Supp. Regs.
in 42 CFR 489.20, 411.25, 489.2
FORMS: 250-254
OMB NO: 0938-0236 EXPIRATION DATE: 06/30/2007
RESPS:3,592 HOURS:704,032 COSTS(000):$0
Independent Renal Dialysis Facility Cost Report and Supporting
Regulations 42 CFR 413.20 and 42 CFR 413.24
FORMS: CMS-265-94
OMB NO: 0938-0242 EXPIRATION DATE: 03/31/2007
RESPS:27,900 HOURS:2,325 COSTS(000):$0
Fire Safety Survey Report Forms and Supporting Regulations in 42
CFR 488.26 and 442.30
FORMS: CMS-2786M 2786R 2786S 2786T 2786U 2786V 2786W 2786X 2786Y
OMB NO: 0938-0245 EXPIRATION DATE: 09/30/2006
RESPS:10,000 HOURS:2,500 COSTS(000):$0
Request for Enrollment in Supplementary Medical Insurance and
Supporting Regulations in 42 CFR 407.10 & 407.11
FORMS: CMS-4040 CMS-4040-SP
OMB NO: 0938-0246 EXPIRATION DATE: 09/30/2006
RESPS:102 HOURS:22,515 COSTS(000):$0
Certification of Medicaid Eligibilty Quality Control (MEQC)
Payment Error Rates and Supporting Regulations at 42 CFR.431.800
through 431.865
FORMS: CMS-301
OMB NO: 0938-0251 EXPIRATION DATE: 09/30/2007
RESPS:50,000 HOURS:12,500 COSTS(000):$0
Application for Hospital Insurance and Supporting Regulations in
42 CFR 406.7
FORMS: CMS-18F5
OMB NO: 0938-0266 EXPIRATION DATE: 02/29/2008
RESPS:4,312 HOURS:2,381 COSTS(000):$0
Ambulatory Surgical Center (ASC) Health Insurance Benefits
Agreement Form, Request for Certification, Survey Report and
Supporting Regulations in 42 CFR 416.41, 416.43, 416.47, and...
FORMS: CMS-377 CMS-378 CMS-R-54 CMS-370
OMB NO: 0938-0267 EXPIRATION DATE: 06/30/2009
RESPS:630 HOURS:300,046 COSTS(000):$0
Comprehensive Outpatient Rehabilitation Facility (CORF)
Eligibility and Survey Forms and Information Collection
Requirements in 42 CFR 485.56, 485.58, 485.60, 485.64...
FORMS: 359 360 R-55
OMB NO: 0938-0269 EXPIRATION DATE: 02/28/2009
RESPS:822 HOURS:411 COSTS(000):$0
Request for Accelerated Payments Supporting Regulations in 42
CFR, section 412.116 & 413.64
FORMS: CMS-9042
OMB NO: 0938-0270 EXPIRATION DATE: 09/30/2007
RESPS:500 HOURS:1,000 COSTS(000):$0
The Financial Statement of Debtor and Supporting Regulations in
42 CFR, Section 405.376
FORMS: CMS-379
OMB NO: 0938-0272 EXPIRATION DATE: 12/31/2006
RESPS:277 HOURS:20,775 COSTS(000):$0
Annual Report on Home and Community-Based Services Waivers and
Supporting Regulations in 42 CFR 440.180 and 441.300-310
FORMS: CMS-372(S)
OMB NO: 0938-0273 EXPIRATION DATE: 12/31/2008
RESPS:2,960 HOURS:740 COSTS(000):$0
Identification of Extension Units of Outpatient Physical
Therapy/Outpatient Speech Pathology Providers and Support Regs.
FORMS: CMS-381
OMB NO: 0938-0279 EXPIRATION DATE: 11/30/2008
RESPS:174,461,278 HOURS:1,997,581 COSTS(000):$0
Medicare Uniform Institutional Provider Bill
FORMS: CMS-1450
OMB NO: 0938-0287 EXPIRATION DATE: 12/31/2008
RESPS:27 HOURS:81 COSTS(000):$0
Withholding Medicare Payments to Recover Medicaid Overpayments
and Supporting Regulations in 42 CFR 447.31
FORMS: R-21
OMB NO: 0938-0296 EXPIRATION DATE: 04/30/2007
RESPS:125 HOURS:6,000 COSTS(000):$0
Provider Reimbursement Manual, Part 1 - Chapter 27, Sections
2721, 2722 and 2725, Request for Exception to End Stage Renal
Disease Composite Rates and
