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:
0920-1154
ICR Reference No:
201610-0920-009
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
HHS/CDC
Agency Tracking No:
16AVC
Title:
CDC/ATSDR Formative Research and Tool Development
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
01/19/2017
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/26/2016
Terms of Clearance:
OMB approves this umbrella generic, and has informed CDC/ATSDR that each individual study should be submitted into ROCIS an a genIC that includes full supporting statement Part A and an accompanying Supporting Statement Part B if any statistical methods are employed for sampling or analyses of data. A complete justification for any incentives offered to respondents will also accompany all substudies submitted under this Generic. Outcomes collected under this generic pathway are intended for internal ATSDR use only and will not be generalized beyond the scope of each study or to broader populations.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2020
36 Months From Approved
Responses
60,000
0
0
Time Burden (Hours)
56,250
0
0
Cost Burden (Dollars)
1,125,000
0
0
Abstract:
CDC proposes a new generic clearance to conduct formative research for developing new tools and methodologies to support agency research, surveillance, and program evaluation activities, and the development and assessment of multi-use tools.
Authorizing Statute(s):
US Code:
42 USC 241
Name of Law: PHSA
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:
81 FR 46680
07/18/2016
30-day Notice:
Federal Register Citation:
Citation Date:
81 FR 73112
10/24/2016
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
35
IC Title
Form No.
Form Name
2019 Updated B Reader Certification Examination
Antibiotic Stewardship in Hospitals Assessment
none, none
Hospital Antibiotic Stewardship Core Element Assessment
,
Feedback Questionnaire
Assessment of the Zika Care Connect Program
0920-1154, 0920-1154, 0920-1154, 0920-1154, 0920-1154
Invitation Email to access Survey - Health Care Professional
,
Reminder Invitation Email to access Survey - Health Care Professional
,
Survey - Healthcare Professional
,
Pop-Up Invitation to Survey - Website User
,
Survey - Website User
BRFSS Feasibility Experiment for State-specific Module Data Collection in Cell Phone Samples
0920-1154
Questionnaire Content
BRFSS Preliminary Experiment for Sample and Mode
Behavioral Determinants of Community Hand Hygiene Behavior: A Formative Qualitative Evaluation
0920-1154, 0920-1154
Online Screener
,
Focus Group Moderator Guide
CDC's Inside Knowledge Campaign: 2018 Focus Group Research and Testing with the General Public and Hispanic Audiences
n/a, n/a, n/a, n/a
English Language Screening Instrument
,
Spanish Language Screening Instrument
,
English Language Focus Group Discussion Guide
,
Spanish Language Focus Group Discussion Guide
Clinician Preferences for CDC Clinical Guidelines
Core Elements of Antimicrobial Stewardship in Nursing Homes
none
Prescriber Assessment
Determination of Attitudes Regarding Noise in Construction
0920-1154, 0920-1154, 0920-1154, 0920-1154
Construction Industry Executive/Decision-Maker In-Depth Interviews
,
Construction Supervisor/Foreman Focus Group
,
Construction Workers Focus Groups (ENGLISH)
,
Construction Workers Focus Groups (SPANISH)
Disability and Health Data System Evaluaton Survey
0920-1154
Disability and Halth Data System Evaulation Survey
Ethnicity & Race: Messaging to Improve Patient-Provider Communication and Engagement on Risks of Alcohol Use During Pregnancy
0920-1154, 0920-1154, 0920-1154, 0920-1154
Consent Form Provider (Online Survey)
,
Consent Form Provider In-Depth Interview
,
Consent Form Women In-Depth Interview
,
Provider Screener and Online Survey
FORMATIVE RESEARCH TO DEVELOP ZIKA TOOLS FOR HEALTHCARE PROVIDERS
0920-1154, 0920-1154, 0920-1154
ACOG Zika Virus Survey
,
Focus Group Recruitment Screen
,
ACOG Evaluation of Local Health Department Initiative
Federal Select Agent Program eFSAP Feedback Survey
0920-1154, 0920-1154
FSAP Survey System Enhancement
,
FSAP User Experience Survey
Focus Groups of US Adults KAP of Foodborne Disease Outbreaks and Illness Prevention
none, none
Recruitment Screener
,
Recruitment Follow-up Contact
Formative Assessment of Barriers to Transition from Adolescent to Adult for Individuals with Congenital Heart Defects
none
Survey of Parents of Adolescents with Congenital Heart Defects
Formative Assessment of the Information Needs to Prevent Skin Cancer Among Spanish speaking Outdoor Workers
Formative Assessment of the Information Needs to Prevent Work-related Musculoskeletal Disorders and Falls among Aging Retail Workers
Formative Evaluation for Shigellosis Sexual Health Materials for Men who have Sex with Men
none
Screener
Formative Research for Sepsis and Antibiotic Use Campaigns
none, none, none, none, none, none, none, none, none, none, none, none, none, none, none
Sepsis Consumer Screener - mothers
,
Sepsis Consumer Screener - healthy adults 65+
,
Sepsis Consumer Screener - AA men
,
HCP Sepsis Screener - ED triage nurse
,
HCP Sepsis Screener - NP or PA
,
HCP Sepsis Screener - PCP
,
HCP Sepsis Screener - Gen med ward
,
Consumer Interview Sepsis
,
HCP Interview Sepsis
,
HCP Antibiotic Use Screener
,
Consumer Screener - SD-SE
,
Consumer Screener - CD - CE
,
HCP Antibiotic Use Interview
,
Consumer Interview - SE - SD
,
Consumer Interview - CE - CD
Formative Research to Assess Pediatric Healthcare Providers Knowledge, Attitudes and Practices around Zika Virus
none
Survey of Experiences with and Attitudes towards Zika Virus
Formative Research to Develop an Open Data Standard for Reporting Environmental Health Data
0920-1154
Key Informant Interview Plan
Formative Research to Identify Common and Unique Barriers to the Exchange of Hospitalization and ED Data
none, none, none
Survey
,
Survey - word
,
Survey prenotice
Formative Research to Inform an Intervention to Improve Early Detection and Surveillance of Pneumoconiosis in US Coal Miners
none, none, none
Interview demographic survey
,
Focus group demographic survey
,
Interview sign-up
Formative Research with Clinicians for the Development of Quantitative Metrics to Improve Antibiotic Prescribing Behavior in the Outpatient Setting
Increase Enrollment in the CDC-Recognized Lifestyle Change Program (LCP)
NA, NA, NA, NA
Pre-Session Survey
,
Post-Session Survey
,
Enrollment Materials and Referral Tracking Form
,
LCP Staff/Coach Interview Guide
Older Adult Mobility Ride Share (OAMRS)
0920-1154, 0920-1154, 0920-1154, 0920-1154, 0920-1154, 0920-1154, 0920-1154
Written Questionnaire Focus Group
,
Focus Group Protocol - Users
,
Focus Group Protocol - Non-Users
,
Interview Protocol - Users
,
Interview Protocol - Non-Users
,
Screener Focus Group
,
Screener Telephone Interview
Participatory Mapping to Identify and Support At-Risk Populations in Emergency Preparedness – Phase 3
0920-1154
Survey Disaster Planners
Participatory Mapping to Identify and Support at-Risk Populations in Emergency Preparedness
Participatory Mapping to Identy and Support at Risk Population in Emergency Preparedness -- Phase 2
Persuasive Communication about Risks from and Responses to Zika – State, Local and Tribal Government Interviews
NA
Interview Guide - Public Health Officials
Persuasive Communication about Risks from and Responses to Zika: FOCUS GROUPS
NA
Focus Group - Vignette
Reaching Minority Men Where They Are – Formative Research to Build Capacity for Enrollment in Diabetes Prevention and Management Programs
n/a, n/a, n/a, n/a, n/a
Focus Group Guide: Minority Men at Risk for Type 2 Diabetes
,
Focus Group Guide: Minority Men Diagnosed with Type 2 Diabetes
,
Screener
,
Initial Screen Shot of the Web-based Survey (with OMB control information)
,
Survey (content)
Reframing How We Talk About Alcohol
none
Screener
Zika Family Survey: In-Depth Interviews with Women Affected by Zika Virus
0920-1154
IN-DEPTH INTERVIEWS WITH WOMEN AFFECTED BY THE ZIKA VIRUS - INTERVIEW GUIDE
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
60,000
0
0
60,000
0
0
Annual Time Burden (Hours)
56,250
0
0
56,250
0
0
Annual Cost Burden (Dollars)
1,125,000
0
0
1,125,000
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:
This is a new generic ICR.
Annual Cost to Federal Government:
$474,091
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:
10/26/2016
An official website of the United States government
The .gov means it's official.
The site is secure.
