ICR Documents

Supporting Statement A Document Date Uploaded SSA_0920-1166 [NCEH] 040523_CDC.docx 04/24/2023 Supporting Statement B Document Date Uploaded 1 - SSB PCCPHE Revision_20221109.docx 11/18/2022 Supplementary Documents Title Document Document Type Date Uploaded Authorizing Legislation Att1 Authorizing Legislation.pdf Supplementary Document 02/18/2020 60d FRN - published Att2_60D FRN PCCPHE.pdf Supplementary Document 11/18/2022 Map of US Poison Control Centers Att3_Poison Center Map.pdf Supplementary Document 11/18/2022 CDC-AAPCC Data License Agreement Att4_Data Licensing Agreement.pdf Supplementary Document 11/18/2022 Step-by-Step Use of Generic Clearance Att9_Step-by-Step How to Use the Generic Clearance.docx Supplementary Document 11/18/2022 Advance Notification Email for OMB - sample Att10_Advanced Notification Email for OMB.docx Supplementary Document 11/18/2022 GenIC Request for Approval - Template Att11_GenIC Rqst Apprvl Form PCCPHE.docx Supplementary Document 11/18/2022 Consent/Assent Forms - sample Att12_Sample Consent and Assent Forms.docx Supplementary Document 11/18/2022 Adult Questionssaire - sample Att5_Example Adult Questionnaire.docx Supplementary Document 11/18/2022 Adolescent Questionnaire - sample Att6_Example Adolescent Questionnaire.docx Supplementary Document 11/18/2022 Parent Questionnaire - sample Att7_Example Parent-Child Questionnaire.docx Supplementary Document 11/18/2022 Burden Memo Att13_Burden Memo PCCPHE.docx Supplementary Document 11/18/2022 Research Determination Att16_NCEH STARS Determination PCCPHE.pdf Supplementary Document 11/18/2022 Dataset for Questionnaire - example Att8_Example Web Questionnaire.pdf Supplementary Document 11/18/2022 Privacy Impact Assessment Att14_Privacy Impact Assessment PCCPHE.pdf Supplementary Document 11/18/2022 Agreement to Prohibit CDC from Receiving Identifying Key Att15_Agreemnt Prohibit Identifiers.pdf Supplementary Document 11/18/2022 List of Attachment 1 - List of Attachments PCCPHE_20221109.docx Supplementary Document 11/18/2022 Privacy Act Checklist 0 - PCCPHE ICR Privacy Act Checklist 20221109.docx Supplementary Document 11/18/2022 Justification - Quarterly burden 2020Q1 0920-1166 Change Request Justification FY2020 Q1.docx Justification for No Material/Nonsubstantive Change 01/23/2020 Public Comments Author Name Comment Document Author Affiliation Sponsoring Org. Type Category Date of Comment Date Comment Received