View Information Collection Request (ICR) Package
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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:
202011-0920-003
Status:
Historical Active
Previous ICR Reference No:
201711-0920-012
Agency/Subagency:
HHS/CDC
Agency Tracking No:
0920-0879
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:
01/13/2021
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/30/2020
Terms of Clearance:
Previous Terms of clearance continue: Approved consistent 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 collections 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
01/31/2024
36 Months From Approved
01/31/2021
Responses
162,000
0
162,000
Time Burden (Hours)
162,000
0
162,000
Cost Burden (Dollars)
3,763,260
0
3,763,260
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:
85 FR 30962
05/21/2020
30-day Notice:
Federal Register Citation:
Citation Date:
85 FR 73718
11/19/2020
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
15
IC Title
Form No.
Form Name
Improving Processes for Identifying and Reporting Disaster-Related Deaths CDC Guidance Knowledge Assessment
Focus Group Moderator Guide, Survey
0920-22ID
,
0920-22ID
Pandemics, Natural Disasters, and other Interruption of Service Events: Contingency Planning Considerations for Mycobacteriology Testing
0920-0879, 0920-0879
Online Instrument
,
Focus Group Instrument
State, Tribal, Local, and Territorial PHIT Attendee Follow-up Survey
0920-0879
State, Tribal, Local, and Territorial PHIT Attendee Follow-up Survey
[CSELS] Six-Month Follow-up Survey of PHIT Registrants from PH Agencies
0920-0879
Six-Month Follow-up Survey of PHIT Registrants from Public Health Agencies
[CSTLTS / NCEH] Exploration of CDC and WIC Partnerships for Childhood Lead Poisoning Prevention
None
CLPPP-WIC Workgroup Interview Questions
[CSTLTS, NCIRD] Pediatric Hepatitis-Adenovirus Case Control Evaluation, United States, 2022 – 2023
0920-0879, 0920-0879, 0920-0879, 0920-0879, 0920-0879
Pediatric Hepatitis - MEDICAL RECORD ABSTRACTION FORM
,
Pediatric Hepatitis - Exposure Questionnaire
,
Pediatric Hepatitis - Exposure Questionnaire (Spanish)
,
Pediatric Hepatitis - Exposure Questionnaire CONTROL
,
Pediatric Hepatitis - Exposure Questionnaire CONTROL (Spanish)
[CSTLTS] ATSDR Public Health Surveillance Stakeholder Input and Priorities
n/a
ATSDR Stakeholder Survey to Determine Surveillance Needs
[CSTLTS] Assessing Outcomes of the CDC-Harvard Program Evaluation Practicum in Building Program Evaluation Capacity in STLT Maternal and Child Health Programs (2023)
None, None, None, None, None, None, None, None, None, None
Training Feedback from 2023 MCH Program Participants (3-Month Survey)
,
Training Feedback from 2023 MCH Program Participants (3-Month Survey) (screen shots)
,
Progress of Evaluation Implementation from 2023 CDC Harvard Practicum Participants (6-Month Survey)
,
Progress of Evaluation Implementation from 2023 CDC Harvard Practicum Participants (6-Month Survey) (screen shots)
,
Evaluation Progress and Capacity Assessment among 2023 CDC Harvard Practicum Participants (12-Month Survey)
,
Evaluation Progress and Capacity Assessment among 2023 CDC Harvard Practicum Participants (12-Month Survey) (screen shots)
,
Evaluation Progress and Capacity Building among Participants from the 2023 CDC Harvard Practicum (12-Month Interview)
,
Evaluation Progress and Capacity Assessment among Past CDC Harvard Practicum Participants (2018-2022) (SURVEY)
,
Evaluation Progress and Capacity Assessment among Past CDC Harvard Practicum Participants (2018-2022) (SURVEY) (screen shots)
,
Evaluation Capacity and Practicum Experience among Past Practicum Participants (2018-2022) (INTERVIEW)
[CSTLTS] Disease Intervention Specialist (DIS) Workforce Assessment
0920-0879, 0920-0879
Disease Intervention Professional Enumeration Study (Local)
,
Disease Intervention Professional Enumeration Study (State & Territorial)
[CSTLTS] Early Care and Education (ECE) State Indicator Assessment 2022
None
Early Care and Education (ECE) 2022 State Indicator Assessment
[CSTLTS] Emergency Response and Planning Time Motion Study Data Collection
0920-0879-23EX, 0920-0879-23EX
Attachment A- Participant Exercise Overview Form
,
Attachment B- Time Motion Data Collection Excel
[CSTLTS] National Syndromic Surveillance System Program's BioSense Platform Assessment, 2023
None, None
NSSP BioSense Platform User Assessment, 2023
,
NSSP BioSense Platform User Assessment for Site Administrators, 2023
[CSTLTS] OT21-23 Success Stories
0920-23EV
Attachment C_OT21-2103 Success Stories Form- Word
[CSTLTS] Pilot Reporting of Cancer Inquiries by the Public to STLT Partners
n/a, n/a, n/a
Cancer Intake Inquiry Form - Redcap
,
Cancer Intake Inquiry Form - EpiInfo
,
Annual Report of Cancer Inquiries to STLTs
[CSTLTS] Six-Month Follow-up Survey of PHIT Registrants from PH Agencies
0920-0879
Six-Month Follow-up Survey of PHIT Registrants from PH Agencies
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
3,763,260
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:
$92,950
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?
No
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:
11/30/2020