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 ICR - OIRA Conclusion
OMB Control No:
0920-1412
ICR Reference No:
202507-0920-009
Status:
Active
Previous ICR Reference No:
202305-0920-013
Agency/Subagency:
HHS/CDC
Agency Tracking No:
0920-23AA
Title:
[NCIPC] DELTA Achieving Health Equity through Addressing Disparities (AHEAD) COOPERATIVE AGREEMENT EVALUATION
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:
07/14/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
07/11/2025
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2026
08/31/2026
08/31/2026
Responses
42
0
52
Time Burden (Hours)
158
0
163
Cost Burden (Dollars)
0
0
0
Abstract:
The purpose of this data collection is to collect monitoring data project performance and implementation of cooperative agreement for Domestic Violence Prevention Enhancement and Leadership Through Alliances (DELTA) Achieving Health Equity through Addressing Disparities (AHEAD). Information collected from recipients on state- and local-level will provide crucial data for performance monitoring of the cooperative agreement and will provide CDC with the capacity to respond in a timely manner to requests for information about the program from the Department of Health and Human Services (HHS), the White House, Congress, and other sources. Recipients will report progress and activity information to CDC on an annual schedule using a web-based Partners’ Portal and web-based survey tool. This Non-Substantive Change Request is submitted to make updates to questions used in OMB 0920-1412 - DELTA Achieving Health Equity through Addressing Disparities (AHEAD) COOPERATIVE AGREEMENT EVALUTATION to be in accordance with EO 14168 & EO 14151. There is a net decrease of 5 burden hours.
Authorizing Statute(s):
None
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 62859
10/17/2022
30-day Notice:
Federal Register Citation:
Citation Date:
88 FR 37884
06/09/2023
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
4
IC Title
Form No.
Form Name
Annual Performance Report
0920-23AA, 0920-1412
Att. 3a APR Tool
,
APR Tool - 11JUL2025
Health Equity Capacity Assessment
0920-23AA
Att. 6a Health Equity Capacity Assessment Updated
Key Informant Interview Evaluator
0920-1412, 0920-23AA
Att. 4b Key Informant Interview Protocol - Evaluator
,
Key Informant Interview Protocol - Evaluator - 11JUL2025
Key Informant Interview – Project Lead
0920-23AA, 0920-1412
Att. 4a Key Informant Interview Protocol - Project Lead
,
Key Informant Interview Protocol - Project Lead - 11JUL2025
Prevention Infrastructure Assessment
0920-23AA, 0920-1412
Att. 5a Prevention Infrastructure Assessment Tool Updated
,
Prevention Infrastructure Assessment Tool - 11JUL2025
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
42
52
0
-10
0
0
Annual Time Burden (Hours)
158
163
0
-5
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
Non-Substantive Change Request is submitted to make updates to questions used in OMB 0920-1412 - DELTA Achieving Health Equity through Addressing Disparities (AHEAD) COOPERATIVE AGREEMENT EVALUTATION to be in accordance with EO 14168 & EO 14151. Health Equity Capacity Assessment form is being removed. There is a net decrease of 5 burden hours.
Annual Cost to Federal Government:
$38,832
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:
07/11/2025
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