Cognitive Testing and Pilot Testing for the National Center for Chronic Disease Prevention and Health Promotion

Forms and Documents

Document Name	Status
Feasibility Testing for Collection of BRFSS Supplemental Data Using Web-Based Methods - Pilot Testing Form	New
NCCDPHP GCT SSA 12-16-2019 (2).docx Supporting Statement A	2019-12-16
Att 9. NCCDPHP GCT Cover Form Final.docx Supplementary Document	2019-12-16
Att 7. NCCDPHP GCT Multimode Pilot Final Report Final.docx Supplementary Document	2019-12-16
Att 6. NCCDPHP GCT Screener to Participate in Cognitive Testing Exam Final.docx Supplementary Document	2019-12-16
Att 5. NCCDPHP GCT Vendor Cognitive Testing Rpt Exam Final.docx Supplementary Document	2019-12-16
Att 4. NCCDPHP GCT NCCDPHP Divisions Final.docx Supplementary Document	2019-12-16
Att 3. NCCDPHP GCT Quest Proposal Proc Exam from the BRFSS Final.docx Supplementary Document	2019-12-16
Att 2. Published 60-day FRN Final.pdf Supplementary Document	2019-12-16
Att 1. NCCDPHP GCT Authorizing Legislation Final.pdf Supplementary Document	2019-12-16
NCCDPHP GCT SSB Final.docx Supporting Statement B	2019-12-16

IC Document Collections

IC ID	Document Title	Status
242498	Feasibility Testing for Collection of BRFSS Supplemental Data Using Web-Based Methods - Pilot Testing Form	New

ICR Details

OMB Control No: 0920-1291	ICR Reference No: 201912-0920-011
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-19BND
Title: Cognitive Testing and Pilot Testing for the National Center for Chronic Disease Prevention and Health Promotion
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 without change	Conclusion Date: 03/26/2020
	Date Received in OIRA: 12/23/2019
Terms of Clearance: CDC will continue to submit individual collections under this generic clearance to OMB.These submissions will include the actual study instruments along with a memo describing the specific study goal, the study design, any incentives to be used, and the sampling and analysis plans. Please notify the OIRA desk officer via email when a new IC is submitted to ROCIS to ensure prompt attention. Standard remuneration of respondents for cognitive testing ($40) and focus groups ($75) applies until research is presented suggesting these rates should be changed or in situation where evidence already exists that a particular subpopulation requires a higher incentive.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2023	36 Months From Approved
Responses	52,500	0	0
Time Burden (Hours)	26,850	0	0
Cost Burden (Dollars)	658,900	0	0

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Abstract: The purpose of this project is to provide a generic information collection to allow for cognitive and pilot testing for the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Cognitive testing and pilot testing are used to test survey questions and survey methodologies under consideration by NCCDPHP divisions and programs.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
  

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:
	84 FR 40061	08/13/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 70192	12/20/2019
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Feasibility Testing for Collection of BRFSS Supplemental Data Using Web-Based Methods - Pilot Testing	none, none, none	BRFSS questionnaire ,   RDD Push to Web Recruitment ,   Internet Panel Recruitment

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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	52,500	0	0	52,500	0	0
Annual Time Burden (Hours)	26,850	0	0	26,850	0	0
Annual Cost Burden (Dollars)	658,900	0	0	658,900	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 collection request.

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Annual Cost to Federal Government: $807,632

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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? 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: 12/23/2019

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