Evaluation of a Concussion Tool Kit - Heads Up: Concussion in High School Sports

Forms and Documents

Document Name	Status
Form Do not use, not th Evaluation of a Concussion Tool Kit - Heads Up: Concussion in High School Sports Form and Instruction	Modified
Form Appendix D and App Heads Up: Concussions in High School Sports Form and Instruction	New
0920-0674 Heads Up OMB package 05 10 06 submitted to OMB 8.22.06.doc Justification for No Material/Nonsubstantive Change	2006-08-22

IC Document Collections

IC ID	Document Title	Status
7142	Evaluation of a Concussion Tool Kit - Heads Up: Concussion in High School Sports Form and Instruction	Modified
44892	Heads Up: Concussions in High School Sports Form and Instruction	New

ICR Details

OMB Control No: 0920-0674	ICR Reference No: 200608-0920-001
Status: Historical Active	Previous ICR Reference No: 200411-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluation of a Concussion Tool Kit - Heads Up: Concussion in High School Sports
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: 08/29/2006
	Date Received in OIRA: 08/22/2006
Terms of Clearance: Approved consistent with CDC memo (see below) and the prior terms of clearance John, Thanks again for taking time to discuss the modification of the tool kit with us today. Attached is the final report regarding the survey results and we would like to clarify the following item a. CDC’s NCIPC does not intend for the national sample used in the Heads UP tool kit data collection to be nationally representative. b. Any state to state comparison will be conducted solely for exploratory purposes and are not intended to represent any state estimates. Please let us know if you need anything else. Melissa Gipson Public Health Analyst CDC/NCIPC/OPPE Atlanta, GA 30341 (770) 488-4493

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2008	01/31/2008	01/31/2008
Responses	5,445	0	4,045
Time Burden (Hours)	534	0	301
Cost Burden (Dollars)	0	0	0

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Abstract: Every year about 1.5 Americans sustain a traumatic brain injury (TBI) of those it's estimated that 300,000 are sports-related. NCIPC has developed a tool kit for coaches and plans to distribute the kit nationally. The tool kit is made up of materials in English and Spanish, a pocket card for quick references, a video and fact sheets for coaches and parents. The aim is to raise awareness and educate coaches about concussion; help coaches educate their athletes, parents, and other school officials about concussion. This study will pilot est the coaches tool kit and provide feedback.....

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Authorizing Statute(s): None

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

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Evaluation of a Concussion Tool Kit - Heads Up: Concussion in High School Sports	Do not use, not the original document.	Do not use, not the original document.
Heads Up: Concussions in High School Sports	Appendix D and Appendix E	Heads Up: Concussions in High School Sports

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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	5,445	4,045	0	1,400	0	0
Annual Time Burden (Hours)	534	301	0	233	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: The increase in burden is due to the pilot study going live. In the previous clearance, the program indicated to OMB that they will be coming back after the pilot for the approval of the full study.

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Annual Cost to Federal Government: $0

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

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: 08/22/2006

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