View Information Collection Request (ICR) Package
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IC List
Burden
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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:
201711-0920-012
Status:
Historical Active
Previous ICR Reference No:
201412-0920-011
Agency/Subagency:
HHS/CDC
Agency Tracking No:
Title:
Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
01/17/2018
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/21/2017
Terms of Clearance:
Previous 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
01/31/2021
36 Months From Approved
03/31/2018
Responses
162,000
0
162,000
Time Burden (Hours)
162,000
0
162,000
Cost Burden (Dollars)
3,763,260
0
0
Abstract:
CDC requests an extension to the generic clearance to continue to collect information related to domestic public health issues and services that affect state, tribal, local, and territorial STLT governmental entities.
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:
82 FR 19371
04/27/2017
30-day Notice:
Federal Register Citation:
Citation Date:
82 FR 40583
08/25/2017
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
33
IC Title
Form No.
Form Name
2020 Carbapenem Resistance Veterinary Diagnostic Laboratory Survey
n/a
2020 Carbapenem Resistance Veterinary Diagnostic Laboratory Survey
Assessment of Colorectal Cancer Control Program Implementation at Health System Clinic Sites
0920-20PX
Colo-rectal Cancer Control Program Survey
Assessment of Partnerships Impacting STD Outcomes in Areas of Service Reduction
0920-0879, 0920-0879, 0920-0879, 0920-0879, 0920-0879, 0920-0879
STD Program Manager Referral Form
,
In-Person Interview Referral Form
,
Web-based Assessment Instrument
,
In-Person Interview Guide - Local STD Program Manager
,
In-Person Interview Guide - Local STD Program Coordinator
,
In-Person Interview Guide - Local Data Manager/Epidemiologist
Assessment of STLT Public Health Agencies to Guide the Update of CDC/ATSDR Cancer Cluster Guidelines
none, none
Assessment -word
,
Assessment - web
Assessment of the National Health Security Index for Public Health Preparedness
none, none
National Health Security Preparedness Index Assessment
,
National Health Security Preparedness Index Assessment - word
CDC Newborn Screening Quality Assurance Program – Spinal Muscular Atrophy (SMA) Proficiency Testing (PT) Pilot
n/a, n/a
NSQPA Pilot SMA PT Data Reporting Form
,
NSQAP Pilot SMA PT Program Customer Feedback Form
CDC Project Officer Support: SHD Officials Assessment
0920-0879
CDC Projct Oficer Effectiveness and Satisfaction Assessment: Instrument Guidance
Community of Practice Member Satisfaction and Needs Assessment
none, none
Community of Practice Assessment - word
,
Community of Practice Assessment - web
DROUGHT-IC
0920-0879
DROUGHT Preparedness and Response Assessment Tool (DEMO)
Determining the Landscape of QMSs for PHLs Performing NGS (LD)
0920-20PD
NGSQUAL-NA
EBP-PHPR
none, none
Assessment - Web version
,
Assessment - Word version
Environmental Health Workforce Current and Emerging Challenges Assessment
0920-0879, 0920-0879, 0920-0879, 0920-0879, 0920-0879
Recruitment Instrument - State Health Department EH Professional
,
Recruitment Instrument - Tribal Health Department EH Professional
,
Recruitment Instrument - Local Health Department EH Professional
,
Recruitment Instrument - Territorial Health Department EH Professional
,
Focus Group Facilitation Guide - STLT EH Professionals
HIV Partner Services HIPEP Assessment
none, none
Partner Services Assessment - web
,
Partner Services Assessment - word
Medical Countermearsure Training Needs Assessment
NCCCP Program Improvement Assessment
none, none
NCCCP Assessment - word
,
NCCCP Assessment
NOFO: Assessment of Language and Structure
none
NOFO Assessment
NSSP BioSense Platform User Assessment: Functionality and Utility
n/a
The NSSP BioSense Platform User Assessment
National Syndromic Surveillance Program Community of Practice Assessment
none, none
Community of Practice Assessment - word
,
Community of Practice - web
PHEP Success Story Assessment
0920-0879, 0920-0879
PHEP Instrument Web
,
PHEP Instrument Word version
Pandemic Influenza: Assessing the Feasibility and Acceptability of Implementing the 2017 Community Mitigation Guidelines and Recommendations (CMG-EVAL)
n/a, n/a
SurveyMonkey Survey for the Directors of Public Health Preparedness
,
Qualtrics Survey for Local Health Department Preparedness Coordinators
Pre-Hospital Stroke Systems of Care: Emergency Medical Service System (EMSS) Implementation Assessment
0920-0879
Interview Guide
Prevention and Control of Shigellosis: A Needs Assessment of State and Local Health Departments
n/a
Telephone Interview guide
Public Health Ethics Activities at State and Local Health Departments: Current Status and Challenges
0920-0879, 0920-0879
Telephone Interview Guide
,
Online Survey Instrument_Web version
Public Health in Indian Country Capacity Scan Assessment (PHICCS)
0920-0879, 0920-0879, 0920-0879
PHICCS Instrument - Web Version
,
PHICCS Phone Administration of Instrument - Introduction
,
PHICCS Phone Administration of Instrument - Word Version
Qualitative Assessment of CDC-funded Local Health Dept Violence Prevention Efforts
RAWMILKPR - Unpasteurized Milk Outbreaks: An Assessment of the Legal Landscape, Outbreak Investigations, and Prevention at the State Leve
0920-0879
Unpasteurized Milk Outbreak Prevention Survy
SLPHERLT
0920-0879, 0920-0879
Web-Based Assessment
,
Focus Group Facilitation Guide
STD Prevention and Control: Workplan Template Pilot
none, none
STD Applicant Workplan Template - 5 year plan
,
STD Applicant Workplan Template - 1 year plan
Spinal Muscular Atrophy (SMA) Proficiency Testing (PT) Pilot
none, none
Data Reporting Page
,
Feedback Form
State Oral Health Program Assessment
n/a, n/a
Online Survey (screen captures)
,
Telephone Interview Guide for State Oral Health Staff
State Oral Health and Chronic Disease Programs Integration Assessment
n/a
Telephone Interview Instrument
The State of State Suicide Prevention: An Environmental Scan
0920-0879, 0920-0879, 0920-0879, 0920-0879
Suicide Prevention Web-based Survey - STT Suicide Prevention Coordinators
,
Suicide Prevention Web-based Survey - STT Suicide Prevention Grant Project Directors
,
Suicide Prevention Web-based Survey - Delegates
,
Suicide Prevention Telephone-based Survey - STT Suicide Prevention Coordinators
Vector Surveillance and Control Assessment: Post Zika-Response and Tick Capacities (VECTOR-PZ)
n/a
2020 Vector Control 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
162,000
0
0
0
0
Annual Time Burden (Hours)
162,000
162,000
0
0
0
0
Annual Cost Burden (Dollars)
3,763,260
0
0
3,763,260
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:
$87,055
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
No
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
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:
11/21/2017