View Information Collection Request (ICR) Package
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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 ICR - OIRA Conclusion
OMB Control No:
0920-1156
ICR Reference No:
201703-0920-010
Status:
Historical Active
Previous ICR Reference No:
201607-0920-001
Agency/Subagency:
HHS/CDC
Agency Tracking No:
0920-16MM
Title:
Performance Monitoring of “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
03/23/2017
Retrieve Notice of Action (NOA)
Date Received in OIRA:
03/22/2017
Terms of Clearance:
Previous terms continue: Approved consistent with the understanding that this collection will measure outcomes intended to facilitate program improvement and development. Collection activities are not intended to produce generalizable outcomes regarding teen pregnancy or reproductive health.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2020
01/31/2020
01/31/2020
Responses
2,064
0
2,064
Time Burden (Hours)
1,150
0
1,150
Cost Burden (Dollars)
0
0
0
Abstract:
CDC obtained the current approval in January 2017. Since submitting the 30 day notice and accompanying materials in June 2016, CDC identified funds that allowed us to support development of an online data collection system intended to make responding simpler by utilizing automatic skip patterns while also simplifying data submission. In the process of developing the online data collection system, we noted places in the currently approved measures that would need slight modifications (e.g., small changes to directions, changing from a table to a question format) in order to function correctly in the online measures. We also noted places where the measures could be made clearer. As a result, CDC is now requesting approval of these minor changes to the previously approved versions of the measures that were created in word. There is no change in burden associated with these changes.
Authorizing Statute(s):
US Code:
42 USC 241
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:
81 FR 6270
02/05/2016
30-day Notice:
Federal Register Citation:
Citation Date:
81 FR 45166
07/12/2016
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
17
IC Title
Form No.
Form Name
Annual Health Center Performance Measure Reporting Tool
N/A, N/A
Att 8 Annual Health Center Perfornce Meure Repting Tool clean
,
Att 8a Annual Health Center Performance Measure Reporting Tool Online Version
Annual Health Center Performance Measure Reporting Tool
N/A, N/A
Att 8 Annual Health Center Performance Measure Reporting Tool clean
,
Att 8a Annual Health Center Performance Measure Reporting Tool Online Version
Awardee Performance Measure Reporting Tool
N/A, N/A
Att 13 Awardee Performance Measure Reporting Tool clean
,
Att 13a Awardee Performance Measure Reporting Tool Online Version
Awardee Training and Techmnical Assistance Tool
NA
Awardee Training and Technical Assistance Tool
Health Center Organizational Assessment
NA
Health Center Organizational Assessment
Health Center Organizational Assessment
N/A, N/A
Att 4 Health Center Organizational Assessment 03_01_2017 clean
,
Att 4a Health Center Organizational Assessment Online Version
Health Center Provider Survey
NA
Health Center Provider Survey
Health Center Provider Survey
N/A, N/A
Att 5 Health Center Provider Survey clean
,
Att 5a Health Center Provider Survey Online Version
Health Center Youth Survey
NA
Helath Center Youth Survey
Quarterly Health Center Perfoemance Measure Reporting Tool
NA
Quarterly Health Center Performance Measure Reporting Tool
Quarterly Health Center Performance Measure Reporting Tool
N/A, N/A
Att 7 Quarterly Health Center Performance Measure Reporting Tool clean
,
Att 7a Quarterly Health Center Performance Measure Reporting Tool Online Version
Youth Serving Organization (YSO) Organizational Assessment
N/A
Att 9a YSO Organizational Assessment Online Version
Youth Serving Organization (YSO) Organizational Assessment
N/A, N/A
Att 6a Health Center Youth Survey Online Version
,
Att 6a Health Center Youth Survey Online Version
Youth Serving Organization (YSO) Performance Measure Reporting Tool
N/A
Att 11a YSO Performance Measure Reporting Tool Online Version
Youth Serving Organization (YSO) Performance Measure Reporting Tool
NA
Youth Serving Organization Performance Measure Reporting Tool
Youth Serving Organization (YSO) Staff Survey
NA
Youth Serving Organization (YSO) Staff Survey
Youth Serving Organization (YSO) Staff Survey
N/A, N/A
Att 10 YSO Staff Survey clean
,
Att 10a YSO Staff Survey Online Version
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
2,064
2,064
0
0
0
0
Annual Time Burden (Hours)
1,150
1,150
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$232,215
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:
Jeffrey Zirger 404 639-7118 wtj5@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:
03/22/2017
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