Human Behavior in Fire Study

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form None assigned Human Behavior in Fire Studay - Adults Case and Controls - CAPI questionaire	Form and Instruction	New	Available
Form None assigned Human Behavior in Fire Study - Adults Screened but Ineligible or Refused	Form and Instruction	New	Available
Form None assigned Human Behavior in Fire Study - Adults Screened and Eligible	Form and Instruction	New	Available
Fire Memo.doc	Supplementary Document	Uploaded 2007-01-18	Available
Supporting Statement Human Behavior in Fire Study 9-29-2006 Part B.doc	Supporting Statement B	Uploaded 2006-10-01	Available
Appendix 1_ Section 301.doc	Supplementary Document	Uploaded 2006-10-03	Available
Appendix 6_Participant Consentv4.pdf	Supplementary Document	Uploaded 2006-10-01	Available
Appendix 7_CDCIRBamendment#5Approval 2006.doc	Supplementary Document	Uploaded 2006-10-01	Repair queued
Appendix 7_CDC IRB Approval Notice 2005.pdf	Supplementary Document	Uploaded 2006-10-01	Available
Appendix 8_BattelleIRB HolmesFG487102-10-Sept7-06.pdf	Supplementary Document	Uploaded 2006-10-01	Available
Cover Pages_App. 2-9_Human Behavior Fire.doc	Supplementary Document	Uploaded 2006-10-01	Available
Appendix 9_Sample Size Calculation Table .doc	Supplementary Document	Uploaded 2006-10-01	Available
Appendix 8_UMD and Battelle IRB Approval Notices 2005.pdf	Supplementary Document	Uploaded 2006-10-01	Available
Appendix 8_MarylandIRBrenewal July24-2006.pdf	Supplementary Document	Uploaded 2006-10-01	Available
Appendix 5_Fire Incident Report Form.pdf	Supplementary Document	Uploaded 2006-10-01	Available
Appendix 4_60-Day Federal Register Notice.pdf	Supplementary Document	Uploaded 2006-10-01	Available
Supporting Statement Human Behavior in Fire Study 10-3-2006 Part A.doc	Supporting Statement A	Uploaded 2006-10-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
45667	Human Behavior in Fire Studay - Adults Case and Controls - CAPI questionaire	Form and Instruction	New
45666	Human Behavior in Fire Study - Adults Screened but Ineligible or Refused	Form and Instruction	New
45665	Human Behavior in Fire Study - Adults Screened and Eligible	Form and Instruction	New
178329	Fire Departments		New

ICR Details

OMB Control No: 0920-0734	ICR Reference No: 200610-0920-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Human Behavior in Fire Study
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: 01/18/2007
	Date Received in OIRA: 10/13/2006
Terms of Clearance: Approved consistent with CDC memo submitted to OMB 01/18/07. As soon as possible but no later than 02/09/07, and prior to CDC collecting information under this clearance, the Agency shall submit a copy of the Certificate of Confidentiality to OMB for inclusion in the docket.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2010	36 Months From Approved
Responses	3,377	0	0
Time Burden (Hours)	952	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this data collection is to examine the relationship between individuals' behaviors in response to a residential fire and the occurrence of a fire related injury. The findings from this study will be used to provide risk and protective factors associated with injuries in residential fires that are amenable to intervention and prevention strategies.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Research and investigations generally
  

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:
	70 FR 15626	03/28/2005
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 56150	09/26/2006
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Human Behavior in Fire Study - Adults Screened and Eligible	None assigned	Appendix 2_CATI screener script
Human Behavior in Fire Studay - Adults Case and Controls - CAPI questionaire	None assigned	Appendix 3_CAPI
Fire Departments
Human Behavior in Fire Study - Adults Screened but Ineligible or Refused	None assigned	Appendix 2_CATI screener script

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ICR Summary of Burden

table that charts list 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	3,377	0	0	3,377	0	0
Annual Time Burden (Hours)	952	0	0	952	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 Information Collection Request.

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Annual Cost to Federal Government: $430,717

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]? 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: 10/12/2006

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