View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View Generic ICR - OIRA Conclusion
OMB Control No:
0920-0879
ICR Reference No:
201402-0920-018
Status:
Historical Active
Previous ICR Reference No:
201110-0920-004
Agency/Subagency:
HHS/CDC
Agency Tracking No:
21460
Title:
Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
04/04/2014
Retrieve Notice of Action (NOA)
Date Received in OIRA:
02/28/2014
Terms of Clearance:
Terms of clearance continue: Approved consisent with the understanding that CDC will use this generic specifically for routine communications with public health officials to assess capacity and needs. This would not be the vehicle for submitting ICRs for gathering information from grantees about program performance or gathering in-depth information about programmatic needs. For ICs submitted under this generic ICR, CDC agrees to submit individual colletions to OMB, along with all necessary supporting statements (to include information about research design and analysis, burden estimates, approaches to address non-response bias, etc).
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2017
36 Months From Approved
04/30/2014
Responses
162,000
0
120,240
Time Burden (Hours)
162,000
0
64,440
Cost Burden (Dollars)
0
0
0
Abstract:
CDC requests approval for a revision to the respondent universe to include delegates acting on behalf of STLT health departments involved in the provision of essential public health services in the US.
Authorizing Statute(s):
US Code:
42 USC 301
Name of Law: Public Health Service Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
78 FR 65325
10/31/2013
30-day Notice:
Federal Register Citation:
Citation Date:
79 FR 10526
02/25/2014
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
16
IC Title
Form No.
Form Name
Access to Electronic HCR during Outbreak and Assessment of State PHD Immunization Billing Reimbursement Projects
0920-0879, 0920-0879, 0920-0879, 0920-0879, 0920-0879, 0920-0879
EHR Attachment A_Interview Guide HAI-Epi_041514
,
EHR Attachment B_Interview Guide Counsel
,
EHR Attachment C_Instrument- Word- Phase 1
,
IZPHD Attachment B_Instrument- Web-Phase 1
,
IZPHD Attachment C_Instrument- Word- Phase 1
,
IZPHD Attachment D -Interview Instrument- Phase 2
Assessing Key Factors to Pharmacy Enrollments in the Vaccines for Children Program
Cryptosporidiosis: Diagnostic Laboratory and Reporting Practices (CRYPTO) AND Incidents in the National Poison Data System (POISON CENTERS)
None, None
CRYPTOSPORIDIOSIS Assessment Tool
,
POISON CENTERS Assessment Tool
Effective Educational Campaigns for Private Well Owners
none
Survey screenshots
IZ CORE
Improving State and Local Vector Control Program Performance and School Health "Water Toolkit" Assessment
none, none, none
Vector Control Assessment
,
Water Toolkit Assessment
,
Water Feedback
Mobilizing for Action through Planning and Partnerships (MAPP): Outcomes
none
Online Assessment
Natinal Public Health Improvement Initiative: Program Assessment
PH LAW
PSR
Preparedness for Persons under Investigation for Ebola Virus Disease
none
Assessment on Ebola Inquiries and Preparedness
Public Health Improvement Trainings (PHIT) Assessment
none
Web instrument
Public Health Performance Assessment & Healthy Homes Needs Assessment
none, none
PHP Assessment Screenshots
,
HHA Interview Script and Guide REVISED
Reference Labs
none
Data Collection Instrument
STLT Ebola-Related Activities
Services and Value of Immunization Info Systems and Public Health Emergency Preparedness Capabilities
none, none, none
SVIS - Immunization Info Systems Assessment
,
SVIS - Immunization Info Systems Interview
,
Public Health Preparedness Capabilities Assessment
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
162,000
120,240
0
41,760
0
0
Annual Time Burden (Hours)
162,000
64,440
0
97,560
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
The changes in burden are due to previous errors in the burden numbers that were corrected in a change request but not recorded in ICRAS. In addition, changes in estimates of the number of surveys as well as the average burden per respondent result in fewer annual responses and burden hours. For the requested 3 years of clearance, increases are requested.
Annual Cost to Federal Government:
$80,892
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Shari Steinberg 404 639-4942 sxw2@cdc.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
02/28/2014