OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

ICR 201402-0920-018 · OMB 0920-0879 · Historical Active

Forms and Documents
Document
Name
Status
Form
 New
Form
 New
Form and Instruction
 New
Form
 New
Form
 New
Form
 New
Form and Instruction
 New
Form
 New
Form
 New
Form and Instruction
 New
Supporting Statement B
2014-02-20
Supplementary Document
2014-02-20
Supplementary Document
2014-02-20
Supporting Statement A
2014-02-20
IC Document Collections
IC ID
Document
Title
Status
214223 New
214217 New
214216 New
214212 New
213759 New
213482 New
213377 New
213235 New
213123 New
213041 New
212871 New
212548 New
212458 New
211589 New
211394 New
211315 New
ICR Details
0920-0879 201402-0920-018
Historical Active 201110-0920-004
HHS/CDC 21460
Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery
Revision of a currently approved collection   No
Regular
Approved without change 04/04/2014
Retrieve Notice of Action (NOA) 02/28/2014
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
04/30/2017 36 Months From Approved 04/30/2014
162,000 0 120,240
162,000 0 64,440
0 0 0
CDC requests approval for a revision to the respondent universe to include delegates acting on behalf of STLT health departments involved in the provision of essential public health services in the US.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  78 FR 65325 10/31/2013
79 FR 10526 02/25/2014
No
16
IC Title Form No. Form Name
Preparedness for Persons under Investigation for Ebola Virus Disease none Assessment on Ebola Inquiries and Preparedness
PH LAW
PSR
Improving State and Local Vector Control Program Performance and School Health "Water Toolkit" Assessment none, none, none Vector Control Assessment ,   Water Toolkit Assessment ,   Water Feedback
STLT Ebola-Related Activities
Cryptosporidiosis: Diagnostic Laboratory and Reporting Practices (CRYPTO) AND Incidents in the National Poison Data System (POISON CENTERS) None, None CRYPTOSPORIDIOSIS Assessment Tool ,   POISON CENTERS Assessment Tool
Services and Value of Immunization Info Systems and Public Health Emergency Preparedness Capabilities none, none, none SVIS - Immunization Info Systems Assessment ,   SVIS - Immunization Info Systems Interview ,   Public Health Preparedness Capabilities Assessment
IZ CORE
Access to Electronic HCR during Outbreak and Assessment of State PHD Immunization Billing Reimbursement Projects 0920-0879, 0920-0879, 0920-0879, 0920-0879, 0920-0879, 0920-0879 EHR Attachment A_Interview Guide HAI-Epi_041514 ,   EHR Attachment B_Interview Guide Counsel ,   EHR Attachment C_Instrument- Word- Phase 1 ,   IZPHD Attachment B_Instrument- Web-Phase 1 ,   IZPHD Attachment C_Instrument- Word- Phase 1 ,   IZPHD Attachment D -Interview Instrument- Phase 2
Reference Labs none Data Collection Instrument
Public Health Performance Assessment & Healthy Homes Needs Assessment none, none HHA Interview Script and Guide REVISED ,   PHP Assessment Screenshots
Assessing Key Factors to Pharmacy Enrollments in the Vaccines for Children Program
Mobilizing for Action through Planning and Partnerships (MAPP): Outcomes none Online Assessment
Effective Educational Campaigns for Private Well Owners none Survey screenshots
Public Health Improvement Trainings (PHIT) Assessment none Web instrument
Natinal Public Health Improvement Initiative: Program Assessment
  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 162,000 120,240 0 41,760 0 0
Annual Time Burden (Hours) 162,000 64,440 0 97,560 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The changes in burden are due to previous errors in the burden numbers that were corrected in a change request but not recorded in ICRAS. In addition, changes in estimates of the number of surveys as well as the average burden per respondent result in fewer annual responses and burden hours. For the requested 3 years of clearance, increases are requested.
$80,892
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Shari Steinberg 404 639-4942 sxw2@cdc.gov
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
02/28/2014