View Information Collection Request (ICR) Package
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Certification
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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:
0920-1154
ICR Reference No:
202503-0920-028
Status:
Historical Active
Previous ICR Reference No:
202210-0920-013
Agency/Subagency:
HHS/CDC
Agency Tracking No:
0920-1154-25-0061
Title:
[OS] CDC/ATSDR Formative Research and Tool Development
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:
05/09/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/01/2025
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
03/31/2026
03/31/2026
03/31/2026
Responses
75,000
0
75,000
Time Burden (Hours)
60,000
0
60,000
Cost Burden (Dollars)
0
0
0
Abstract:
CDC/ATSDR requests an extension of a 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. Non-Substantive Change Request submitted to modify language for compliance with EO 14168
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:
87 FR 43860
07/22/2022
30-day Notice:
Federal Register Citation:
Citation Date:
87 FR 62852
10/17/2022
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
55
IC Title
Form No.
Form Name
(NCEZID) Focus Groups with Infectious Disease Physicians and Pharmacists on Antifungal Therapeutic Drug Monitoring
n/a, n/a
Antifungal TDM Focus Group Screener
,
Antifungal TDM Focus Group Guide
Creative Concept Testing on Antimicrobial Resistance
0920-1154, 0920-1154, 0920-1154, 0920-1154
Focus Group Screener for Consumers, Including Parents
,
Interview Screener for Healthcare Providers
,
Focus Group Guide for Consumers about Antimicrobial Resistance Concept Testing
,
Interview Guide for Healthcare Professionals about Antimicrobial Resistance Concept Testing
Feedback Survey for Community Counts Data Viz Tool
0920-1154
Feedback Survey for Community Counts Data Viz Tool
Formative Research for Spanish-Language Drug Overdose Messages
n/a, n/a, n/a, n/a, n/a, n/a
Qualitative Eligibility Screener (Phone)
,
Qualitative Eligibility Screener (Online)
,
Focus Group Moderator Guide
,
Interview Guide
,
Online Survey
,
Respondent Consent Form and Participants Email
In-Depth Interviews with Healthcare Professionals about C. Diff Materials
0920-1154-24ES, 0920-1154-24ES
Antimicrobial Resistance Communications and Media Support Services
,
Antimicrobial Resistance Communications and Media Support Services_Guide HCPs (24ES)
Message Evaluation for CDC's Stop Overdose Campaigns (Broadcast Radio & Digital Ad Surveys)
0920-1154, 0920-1154
Stop Overdose Campaign Evaluation: Fentanyl and Naloxone Campaigns Survey - Broadcast Radio
,
Stop Overdose Campaign Evaluation: Fentanyl and Naloxone Campaigns Survey - Digital Ad
[CPR] Association of Southeast Asia Nations (ASEAN) Public Health Emergency Management (PHEM) Emerging Leaders Program (ELP) Survey
0920-25-0125
ASEAN PHEM WLP Survey
[CPR] Evaluation on Acceptability and Effectiveness of Pilot Project This is a Tabletop Exercise Simulation Tool (T.E.S.T.)
0920-23DA, 0920- 23DF, 0920-23DF
Attachment B_Immediate Post Exercise Survey Questions
,
Attachment C_Follow Up Survey Questions
,
Attachment D_Focus Group Script
[CPR] Pilots Evaluation of Interventions for Building Resilience for State and Local Health Department Staff Responding to Public Health Emergencies
0920-24EB, 0920-24EB, 0920-24EB, 0920-24EB
Pilot Evaluation Pre-Implementation Survey
,
Pilot Evaluation POST-Implementation Survey
,
Staff Focus Groups
,
Leader Focus Groups
[CPR] Successes of and Barriers to Distribution of Personal Protective Equipment (PPE) During the 2024 Dairy Cattle H5N1 Outbreak
n/a, n/a
Personal Protective Equipment Key Informant Interviews
,
Online Survey Questionnaire (to be amended as appropriate following review of KII responses)
[CPR] This is a T.E.S.T.
0920-24GC, 0920-24GC, 0920-24GC
Initial Survey
,
Follow- up Survey
,
Focus Group
[CSELS/DLS]CDC OneLab Network Formative Evaluation
0920-1154-24AR
04_Attachment 1_OneLab Network Survey_10-26-2023
[NCBDDD](genIC) Feedback Survey for Community Counts Data Viz Tool
0920-1154
Feedback Survey for Community Counts Data Viz Tool
[NCCDPHP] Formative Evaluation, Implementation and Rapid Evaluation (FIRE) of Diabetes Self-Management in Disproportionately Affected Populations (DAPs) Provider Listening Sessions (Phase I)
None, None, None, None
DSMES Provider Screener Script and Guidelines
,
Listening Sessions Guide for Providers Who Support People with Learning Disabilities
,
Listening Sessions Guide for Providers Who Support Minority Women
,
Listening Sessions Guide for Providers Who Support People with Mental Health Disorders
[NCEH] Evaluating Content and Usability of CDC's Clinical Heat Guidance
0920-1154, 0920-1154, 0920-1154, 0920-1154
Physician - Survey for Community Health Center Physicians and Non-Physicians on CDC’s Clinician Heat Guidance
,
Non-Physician - Survey for Community Health Center Physicians and Non-Physicians on CDC’s Clinician Heat Guidance
,
Physician - Survey for Community Health Center Physicians and Non-Physicians on CDC’s Clinician Heat Guidance_Spanish
,
Non-Physician - Survey for Community Health Center Physicians and Non-Physicians on CDC’s Clinician Heat Guidance_Spanish
[NCEZID] (genIC) Healthcare Provider Communication Evaluation: Assessing Foodborne Illness and Waterborne Illness Prevention Messages, Knowledge, and Attitudes
0920-1154, 0920-1154, 0920-1154, 0920-1154
Screening/Eligibility Form for Interviews/Focus Groups (24CU)
,
Eligible Participant Screener (24CU)
,
Moderator or Interviewer Guide (24CU)
,
MESSAGES to be TESTED (24CU)
[NCEZID] Communication Evaluation Assessing Foodborne, Waterborne and Mycotic Disease Prevention
0920-1154, 0920-1154, 0920-1154, 0920-1154, 0920-1154
Eligibility Screener - Focus Group
,
Eligible Participant Screener - Focus Group
,
Eligibility Screener - Survey
,
Focus Group Moderator Guide
,
Rapid Online Survey
[NCEZID] Focus Groups with Healthcare Providers on Endemic Mycoses
n/a, n/a, n/a
Focus Group Screener
,
Focus Group Consent Form
,
Focus Group Guide
[NCEZID] Food Safety Communication Evaluation: Assessing Food Safety Messages, Knowledge, and Attitudes
None, None, None, None, None
Eligibility Screener for Focus Group
,
[Additional] Eligible Participant Screener for Focus Group
,
Focus Group Moderator Guide
,
Eligibility Screener for Rapid Survey
,
Rapid Survey
[NCEZID] Harmful Algal Blooms Communication Evaluation
0920-1154, 0920-1154, 0920-1154
Screening/Eligibility Form for Focus Groups (24CX)
,
Eligible Participant Screener for Focus Group (24CX)
,
Focus Group Moderator Guide (24CX)
[NCEZID] Hospital System Approach to Collecting Race, Ethnicity, and Language Data
092061154
NHSN’s REaLI Effort
[NCEZID] In-Depth Interviews about Infection Prevention and Control Practices in Long-Term Care Facilities
n/a, n/a, n/a
DHQP Interview Screener
,
Interview Guide: Resident and Family/Close Friend (Paired Interview)
,
Interview Guide: Family/Close Friend (Follow-Up Interview)
[NCEZID] In-depth Interviews with Hispanic or Latina Women on the Topic of Climate Change and Infectious Diseases
0920-1154, 0920-1154, 0920-1154
RECRUITMENT SCREENER In-Depth Interviews with Hispanic or Latina Women
,
CONSENT FORM In-Depth Interviews with Hispanic or Latina Women
,
MODERATOR INTERVIEW GUIDE In-Depth Interviews with Hispanic or Latina Women
[NCEZID] Public Health Communications Messages and Materials Testing Focused on Antimicrobial Resistance Among the U.S. General Population Pilot Data Collection Project
n/a, n/a, n/a
Recruitment Screener
,
Technology Pre-check
,
AR Formative Evaluation Interview Guide
[NCEZID] Wastewater Surveillance Communication Evaluation: Assessing Water Surveillance Messages, Knowledge, and Attitudes (24CP)
0920-1154, 0920-1154, 0920-1154
Screening/Eligibility Form for Focus Groups
,
Eligible Participant Screener for Focus Group (24CP)
,
Focus Group Moderator Guide (24CP)
[NCIPC] Adolescent Mental Health Journey Mapping Project
n/a, n/a, n/a, n/a, n/a
Screening Survey and Parental Consent
,
LGBTQ+ Teen Screening Survey
,
Adolescent Interview Discussion Guide
,
Adolescent Focus Group Discussion Guide
,
Adolescent Brainstorming Session Discussion Guide
[NCIPC] Adoption Accelerator Social Network Analysis (Formative Research)
0920-24GZ
Sheriffs’ Advice-Seeking Survey
[NCIPC] Adverse Childhood Experiences Prevention Message Development
0920-1154, 0920-1154 , 0920-1154 (24IP), 0920-1154 (24IP), 0920-1154 (24IP)
ACEs Survey and Consent - Revised 25MAR2025
,
ACEs Focus Group Participant Screener - Revised 25MAR2025
,
ACEs Focus Group Consent Form
,
ACEs Partner Interview Consent Form
,
ACEs Partner Interview Guide
[NCIPC] Caring Adults Perceptions on Teen Mental Health
0920-1154 (24HL), 0920-1154 (2HL)
ADULT MENTOR SCREENING SURVEY
,
INTERVIEW DISCUSSION GUIDE
[NCIPC] Caring Adults Perceptions on Teen Mental Health
0920-24HY
Screening Survey
[NCIPC] Formative Evaluation for Transportation Safety Resource for Action Tool
n/a, n/a, n/a, n/a
Email Invitation
,
First Follow-up Email
,
Second Follow-up Email
,
Semi-Structured Interview Guide
[NCIPC] Formative Research for Firearm Violence and Community Violence Messaging
n/a, n/a, n/a, n/a, n/a, n/a
Firearm Injury and Death Survey and Consent
,
Firearm Injury and Death Focus Group
,
Firearm Injury and Death Focus Group Screening
,
Community Violence Survey and Consent
,
Community Violence Focus Group
,
Community Violence Focus Group Screening
[NCIPC] Screening Survey for focus groups and interviews
0920-1154-24CC, 0920-1154 (24CC), 0920-1154 (24CC)
Recruitment Materials - Focus Groups and Interviews - AI/AN Adults
,
Focus Group Guide AI/AN Adults
,
Interview Guide Tribal Health Care Providers (HCPs) and Tribal Leaders
[NCIPC] Youth Audience Message Testing of Substance Use Prevention Messages
n/a, n/a
Parent and Child Screeners
,
Activity Guide
[NCZEID] CDC One Health Zoonotic Disease Prioritization (OHZDP) Evaluation Process
0920-24EH, 0920-24EH, 0920-24EH, 0920-24EH, 0920-24EH, 0920-24EH, 0920-24EH
OHZDP Interest Intake Form
,
OHZDP Baseline Survey
,
OHZDP Facilitator Training Survey
,
OHZDP Participant Survey
,
OHZDP Next Steps Tracker
,
OHZDP Post Workshop Survey
,
OHZDP Retrospective Survey
[NCZEID] Focus Groups and In-Depth Interviews with Travelers and Travel Medicine Specialists
0920-24ID, 0920-24ID, 0920-24ID, 0920-24ID, 0920-24ID, 0920-24ID
Recruitment Screener
,
Consent Form
,
Focus Group Guide
,
Interview Recruitment Screener
,
Travel Med Specialists - Consent Form
,
Travel Med Specialists - Interview Guide
[NCZEID] Focus Groups and Interviews with Consumers and HCPs on Alpha-Gal Syndrome
0920-24CA, 0920-24CA, 0920-24CA, 0920-24CA
Attachment 1 - CDC DVBD - AGS Data Collection - Focus Group Screener - 12.14.23
,
Attachment 5 - CDC DVBD - AGS Data Collection - Focus Group Discussion Guide - 12.14.23
,
Attachment 2 - CDC DVBD - AGS Data Collection - Interview Screener - 12.14.23
,
Attachment 6 - CDC DVBD - AGS Data Collection - Interview Discussion Guide - 12.14.23
[NCZEID] Focus Groups with Consumers on Oropouche
0920-25BP, 0920-25BP
Focus Group Screener
,
Focus Group Discussion Guide
[NCZEID] Formative Communications Assessment on Antimicrobial Resistance
0920-24DM, 0920-24DM, 0920-24DM, 0920-24DM, 0920-24DM, 0920-24DM, 0920-24DM, 0920-24DM, 0920-24DM
Focus Group Screener
,
Focus Group Guide for HCPs about Antimicrobial Resistance
,
Interview Guide for Medical Association about Antimicrobial Resistance
,
Focus Group Screener for Consumers, Including Parents, and Caregivers
,
Focus Group Guide for General Consumers about Antimicrobial Resistance
,
Focus Group Guide for Caregivers about Antimicrobial Resistance
,
In-Depth Interview Screener for Consumers with Previous Antimicrobial-Resistant Infections
,
Interview Guide for Consumers with Past Antimicrobial Resistant Infections on Antimicrobial Resistance
,
Survey on Antimicrobial Resistance Among National Policy Audiences
[NCZEID] Formative Evaluation and Message Testing of Antimicrobial Resistance Among Sandwich Generation Consumers
0920-25BU, 0920-25BU, 0920-25BU
Sandwich Generation Consumer Survey
,
Sandwich Generation ConsumerScreener
,
Sandwich Generation Consumer Focus Group Discussion Guide
[NCZEID] Harmful Algal Blooms Shellfish Communication Evaluation
25-0003, 25-0003, 25-0003
Screener
,
Eligibility Screener
,
Moderator Guide
[NCZEID] Lyme Disease Creative and Message Testing Focus Groups
0920-25-0124
Lyme Disease Screener
[NICPC] Child Abuse and Neglect Prevention Message Development
0920-24BQ, 0920-24BQ, 0920-24BQ
Att 1. CAN Survey and Consent
,
Att 3. CAN Focus Group Eligible Participant Screener 11.21.23
,
Att 3. CAN Focus Group Eligible Participant Screener rev
[NIOSH] Assessment of Task-Based Exposures That May Affect Reproductive Health in Nail Salon Employees
0920-1154, 0920-1154 (24AA)
Nail Salon Exposure Study Questionnaire (24AA)
,
Nail Salon Exposure Study Questionnaire Feedback Form
[NIOSH] Assessment of Task-Based Exposures that may Affect Reproductive Health in Nail Salon Employees
0920-1154, 0920-1154
Nail Salon Exposure Study Questionnaire (24FD)
,
Nail Salon Exposure Study Questionnaire Feedback Form (24FD)
[NIOSH] Developing a Framework to Identify and Address Job Hazards Unique to Women Mine Workers
n/a, n/a, n/a
Focus Group Conversation Guide for Women Mine Workers
,
Focus Group Conversation Guide for Mine Managers and HS Professionals
,
Demo
[NIOSH] Formative Assessment of the Information Needs to Prevent Skin Cancer Among Spanish speaking Outdoor Workers
0920-23GU
Attmt III- Focus Group Guide - English_Spanish
[NIOSH] Formative Needs Assessment for Regional Worker Health Monitoring in a Rural Oil and Gas Basin: A Pilot
0920-25-0059, 0920-25-0059, 0920-25-0059
MVC_Priorities_Interview
,
IVMS_Interview
,
Data_Interview
[NIOSH] Increasing the Impact of NIOSH Heat Stress Products in Outdoor Worker Populations
n/a, n/a, n/a, n/a
Focus Group Guide for Employers/Supervisors
,
Focus Group Guide for Employees - English/Spanish
,
Training for Employers - Pre-test
,
Training for Employers - Post-test
[NIOSH] Keeping Cool: Evaluating NIOSH's Heat Stress Training Module to Inform Resource Development and Research
0920-1154, 0920-1154, 0920-1154, 0920-1154, 0920-1154, 0920-1154
Script for Initial Interview with OSH Managers and Trainers
,
Script for Post-Preparation Interview with Osh Managers and Trainers (Prior to Training)
,
Script for POST-TRAINING INTERVIEW with OSH Managers and Trainers
,
Employee Survey
,
Employee Focus Group Questions
,
NIOSH Heat Stress Training Log
[NOISH] Customer Discovery Interviews with Five NIOSH Audiences
[OLSS] CDC OneLab Formative Evaluation - Key Informant Semi-Structured Interviews
0920-25-0094, 0920-25-0094, 0920-25-0094
Request
,
Key Informant
,
Intake Form
[OLSS] CDC OneLab REACH Formative Evaluation
n/a, n/a, n/a, n/a, n/a
Single Sign-Up Survey
,
Post Course Evaluation Survey
,
User Experience Survey
,
Mini Lesson and Job Aid Survey
,
Pace and non-Pace Evaluation Survey
[OPHDST] CDC ENGAGE Functionality Project
0920-25-0088
Conversation guide
[OPHDST] Foundational User Interviews with the Public
0920-1154, 0920-1154
Foundational Screener (25AB)
,
Foundational Data Collection Interview Scripts (25AB)
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
75,000
75,000
0
0
0
0
Annual Time Burden (Hours)
60,000
60,000
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:
$474,091
Does this IC contain surveys, censuses, or employ statistical methods?
No
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:
05/01/2025