Community Assessment for Public Health Emergency Response (CASPER)

Forms and Documents

Document Name	Status
Flood-Related Community Assessment for Public Health Emergency Response (CASPER) – WV, 2016 Form and Instruction	New
N_WeightAnalyses 12082014 Clean.docx Supplementary Document	2014-12-10
AttachM_SamplePaper.pdf Supplementary Document	2014-06-05
AttachL_SamplePressRelease.pdf Supplementary Document	2014-06-05
AttachK_SampleFrameAndMap.docx Supplementary Document	2014-06-05
AttachJ_SampleIntroAndConsent.docx Supplementary Document	2014-06-05
I StpsCndctng 12052014 Clean.docx Supplementary Document	2014-12-10
AttachH_Burden Memo.docx Supplementary Document	2014-06-05
G RqstAprvl 12052014 Clean.docx Supplementary Document	2014-12-10
AttachF_SampleFinalReport.pdf Supplementary Document	2014-06-05
AttachE_SampleReferralForm.pdf Supplementary Document	2014-06-05
AttachD_SampleTrackingForm.pdf Supplementary Document	2014-06-05
C SmplQnr 12052014 Clean.docx Supplementary Document	2014-12-10
AttachB_60dayFRN.pdf Supplementary Document	2014-06-05
AttachA_AuthLegis.pdf Supplementary Document	2014-06-05
CASPER SupStB 12082014 Clean.docx Supporting Statement B	2014-12-10
CASPER SupStA 12052014 Clean.docx Supporting Statement A	2014-12-10

IC Document Collections

IC ID	Document Title	Status
222058	Flood-Related Community Assessment for Public Health Emergency Response (CASPER) – WV, 2016 Form and Instruction	New

ICR Details

OMB Control No: 0920-1036	ICR Reference No: 201406-0920-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-14RJ
Title: Community Assessment for Public Health Emergency Response (CASPER)
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: 12/11/2014
	Date Received in OIRA: 06/09/2014
Terms of Clearance: The agency is reminded that If a 24- or 72-hour OMB approval is requested, an explanation must be provided as to why it is needed. Specifically, CDC must make a case as to why collection must begin within 24 to 72 hours, and it must be related to a public health need.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	36 Months From Approved
Responses	9,600	0	0
Time Burden (Hours)	4,731	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Community Assessment for Public Health Emergency Response (CASPER) is an effective public health tool designed to quickly provide low-cost, household-based information about a community's needs and health status in a simple, easy-to-understand format for decision-makers. CASPER uses well established, valid epidemiological methods to determine the health status and basic needs of the affected community, allowing officials to prioritize responses and make informed decisions regarding the distribution of resources.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

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:
	79 FR 18553	04/02/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 32959	06/09/2014
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
Flood-Related Community Assessment for Public Health Emergency Response (CASPER) – WV, 2016	NA, NA	WV Flood 2016 CASPER Questionnaire ,   WV Flood 2016 CASPER Referral Form

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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	9,600	0	0	9,600	0	0
Annual Time Burden (Hours)	4,731	0	0	4,731	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 is a new Generic ICR.

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Annual Cost to Federal Government: $98,328

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 06/09/2014

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