Monitoring and Reporting System for the Division of Community Health's Cooperative Agreement Programs

Forms and Documents

Document Name	Status
Private Sector - Special Data Request Form	Unchanged
Private Sector - Semi-annual Reporting Form	Unchanged
Private Sector - Initial population Form	Unchanged
State/Local/Tribal Sector - Special Data Reporting Form	Unchanged
State/Local/Tribal - Semi-annual reporting Form	Unchanged
State/Local/Tribal Sector-Initial population Form	Unchanged
Att3a_DCH-PMD Screen Shots_11 03 16.docx Supplementary Document	2016-12-01
Att3b_DCH-PMD _User Guide_11 03 2016.docx Supplementary Document	2016-12-01
OMB CHANGE REQUEST 11 09 2016.docx Justification for No Material/Nonsubstantive Change	2016-12-01
Att3b_DCH-PMD _User Guide_03 10 2016.docx Supplementary Document	2016-03-15
OMB CHANGE REQUEST 03 14 2016.docx Justification for No Material/Nonsubstantive Change	2016-03-15
SS Part B_03 06 2015.docx Supporting Statement B	2015-03-10
SS Part A_03 06 2015.docx Supporting Statement A	2015-03-10
Att 5_Federal Register Notice.pdf Supplementary Document	2015-01-12
Att 2_List of Awardees.docx Supplementary Document	2015-01-12
Att 1b_ACA PPHF.pdf Supplementary Document	2015-01-12
Att 1a_PHSA.pdf Supplementary Document	2015-01-12

IC Document Collections

IC ID	Document Title	Status
214570	Private Sector - Special Data Request Form	Unchanged
214569	Private Sector - Semi-annual Reporting Form	Unchanged
214568	Private Sector - Initial population Form	Unchanged
214567	State/Local/Tribal Sector - Special Data Reporting Form	Unchanged
214566	State/Local/Tribal - Semi-annual reporting Form	Unchanged
214565	State/Local/Tribal Sector-Initial population Form	Unchanged

ICR Details

OMB Control No: 0920-1053	ICR Reference No: 201612-0920-001
Status: Historical Active	Previous ICR Reference No: 201603-0920-006
Agency/Subagency: HHS/CDC	Agency Tracking No: 17EE
Title: Monitoring and Reporting System for the Division of Community Health's Cooperative Agreement Programs
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: 12/05/2016
	Date Received in OIRA: 12/05/2016
Terms of Clearance: Previous terms continue: Non-substantive change requests will be approved only if the following conditions are met: the data requested is readily available to the awardee, the collection is low burden to the awardee (less than 30 minutes to compile and report the information), and it is related to existing data collected from awardees.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	03/31/2018	03/31/2018
Responses	311	0	311
Time Burden (Hours)	1,596	0	1,596
Cost Burden (Dollars)	0	0	0

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Abstract: CDC DCH is proposing a minor Change, effective immediately, to facilitate awardees reporting critical information in a consistent manner. Specifically, CDC DCH Requests to replace one Screen and its accompanying user guidance in the DCH-PMD with a new Screen and accompanying guidance. The new screen will allow awardees to more thoroughly and reliably report evaluation outcomes. There are no requested changes to the number of respondents, the overall purpose of the information collection, nor the estimated burden per response.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
   PL: Pub.L. 111 - 148 4002 Name of Law: Patient Protection and Affordable Care 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 41691	07/17/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 1636	01/13/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
State/Local/Tribal - Semi-annual reporting	none	DCH screenshots
State/Local/Tribal Sector-Initial population	none	DCH screenshots
State/Local/Tribal Sector - Special Data Reporting	none	Special Data Request
Private Sector - Initial population	none	DCH screenshots
Private Sector - Semi-annual Reporting	none	DCH screenshots
Private Sector - Special Data Request	none	Special Data Request

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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	311	311	0	0	0	0
Annual Time Burden (Hours)	1,596	1,596	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:

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Annual Cost to Federal Government: $178,864

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]? Yes

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: 12/05/2016

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