DOP Cross-Site Program Implementation Evaluation of Overdose Data to Action Program

Forms and Documents

Document Name	Status
Form 0920-20PA Post Information Collection Follow-up Email Form and Instruction	New
Form 0920-20PA Program Manager KII Email Form and Instruction	New
Form 0920-20PA Program Manager FG Email Form and Instruction	New
Form 0920-20PA Focus Group Recruitment Reminder Email Form and Instruction	New
Form 0920-20PA Interview Recruitment Reminder Email Form and Instruction	New
Form 0920-20PA Focus Group Recruitment Email Form and Instruction	New
Form 0920-20PA Interview Recruitment Email Form and Instruction	New
Form 0920-20PA Permission to be Recorded Form and Instruction	New
Form 0920-20PA Focus Group Guide Form and Instruction	New
Form 0920-20PA Key Informant Interview Guide Form and Instruction	New
Attachment O_Research Determination.pdf Supplementary Document	2020-10-26
Attachment N. Privacy Impact Assessment (PIA).pdf Supplementary Document	2020-10-26
Attachment C_List of OD2A Recipients.xlsx Supplementary Document	2020-10-26
Attachment B_60 DY FRN OD2A Cross site Eval.pdf Supplementary Document	2020-10-26
Attachment A_ Authorizing Legislation.docx Supplementary Document	2020-10-26
SSB_OD2A_9.24.20 .docx Supporting Statement B	2020-10-26
SSA_OD2A_9.25.20_KH.docx Supporting Statement A	2020-10-26

IC Document Collections

IC ID	Document Title	Status
244241	Post Information Collection Follow-up Email Form and Instruction	New
244240	Program Manager KII Email Form and Instruction	New
244238	Program Manager FG Email Form and Instruction	New
244237	Focus Group Recruitment Reminder Email Form and Instruction	New
244236	Interview Recruitment Reminder Email Form and Instruction	New
244235	Focus Group Recruitment Email Form and Instruction	New
244234	Interview Recruitment Email Form and Instruction	New
244233	Permission to be Recorded Form and Instruction	New
244232	Focus Group Guide Form and Instruction	New
244231	Key Informant Interview Guide Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202010-0920-013
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-20PA
Title: DOP Cross-Site Program Implementation Evaluation of Overdose Data to Action Program
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 11/04/2020

	Requested	Previously Approved
Expiration Date	24 Months From Approved
Responses	2,076	0
Time Burden (Hours)	574	0
Cost Burden (Dollars)	0	0

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Abstract: This information collection's purpose is to assess the implementation of the Overdose Data to Action (OD2A) program (CDC-RFA-CE19-1904) activities, identify implementation-related factors that may influence the effectiveness of these activities across jurisdictions, explore innovative approaches implemented by different jurisdictions, and provide context to findings of evaluation metrics and outcomes data.

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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:
	85 FR 36206	06/15/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 70163	11/04/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 10

IC Title	Form No.	Form Name
Key Informant Interview Guide	0920-20PA	KII Guide
Focus Group Guide	0920-20PA	Focus Group Guide
Permission to be Recorded	0920-20PA	Permission to be Recorded
Interview Recruitment Email	0920-20PA	Interview Recruitment Email
Focus Group Recruitment Email	0920-20PA	Focus Group Recruitment Email
Interview Recruitment Reminder Email	0920-20PA	Interview Recruitment Reminder Email
Focus Group Recruitment Reminder Email	0920-20PA	Focus Group Recruitment Reminder Email
Program Manager FG Email	0920-20PA	Program Manager FG Email
Program Manager KII Email	0920-20PA	Program Manager KII Email
Post Information Collection Follow-up Email	0920-20PA	Post Information Collection Follow-up Email

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ICR Summary of Burden

	Total Request	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	2,076	0	0	2,076	0	0
Annual Time Burden (Hours)	574	0	0	574	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 collection.

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Annual Cost to Federal Government: $1,143,541

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? No

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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: 11/04/2020

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