Standardized National Hypothesis Generating Questionnaire

Forms and Documents

Document Name	Status
Form No form number Hypothesis Generating Questionnaire for PulseNet Cluster Code Form	New
SupportingStatement B SNHGQ clean 10282013.docx Supporting Statement B	2013-10-30
AttachmentB_SNHGQ_IRB.pdf Supplementary Document	2013-10-30
AttachmentA_SNHGQ_PHSA.pdf Supplementary Document	2013-10-30
SupportingStatement A SNHGQ clean 10292013.docx Supporting Statement A	2013-10-30

IC Document Collections

IC ID	Document Title	Status
209150	Hypothesis Generating Questionnaire for PulseNet Cluster Code Form	New

ICR Details

OMB Control No: 0920-0997	ICR Reference No: 201310-0920-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 20788
Title: Standardized National Hypothesis Generating Questionnaire
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/31/2013
	Date Received in OIRA: 10/31/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2016	36 Months From Approved
Responses	4,000	0	0
Time Burden (Hours)	3,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The goal of this project is to define a core set of data elements to be used for hypothesis generation during multistate foodborne investigations.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: The Public Health and Welfare: Research and Investigations Generally
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 43285	07/24/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 61406	10/09/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Hypothesis Generating Questionnaire for PulseNet Cluster Code	No form number	Hypothesis Generating Questionnaire for PulseNet Cluster Code

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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	4,000	0	0	4,000	0	0
Annual Time Burden (Hours)	3,000	0	0	3,000	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This a resubmission of a new Information Collection Request.

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Annual Cost to Federal Government: $3,564

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

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Common Form ICR:  No

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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: 10/31/2013

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