Survey of Illness and Injury Among Backcountry Users in Yellowstone National Park

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Consent to Further Contact	Form and Instruction	Modified	Available
Yellowstone National Park Backcountry Survey [Paper Version]	Form and Instruction	New	Available
Yellowstone National Park Backcountry Survey [Web-based Version]	Form and Instruction	New	Available
Yellowstone Backcountry Study OMB Protocol Revision_082307_B.doc	Supplementary Document	Uploaded 2007-08-23	Available
YBS Supporting Statement B 060707.doc	Supporting Statement B	Uploaded 2007-06-12	Available
Appendix R_CDC Study Website_060607.doc	Supplementary Document	Uploaded 2007-06-13	Available
Appendix Q_NPS Study Website_060607.doc	Supplementary Document	Uploaded 2007-06-13	Available
Appendix J_IRB Exemption Determination_060707.pdf	Supplementary Document	Uploaded 2007-06-13	Available
Appendix I_60-Day Federal Register Notice_060707.pdf	Supplementary Document	Uploaded 2007-06-12	Available
Appendix E_SEKI Refusal Log_083006.doc	Supplementary Document	Uploaded 2007-06-12	Available
Appendix D_SEKI Consent-to-Further-Contact Form_060707.pdf	Supplementary Document	Uploaded 2007-06-12	Available
Appendix C_SEKI Pilot Study Methodology_060607.doc	Supplementary Document	Uploaded 2007-06-12	Available
Appendix B_US Code Title 42 Public Health and Welfare.doc	Supplementary Document	Uploaded 2007-06-12	Available
Appendix A_NPS Directors Order 83.doc	Supplementary Document	Uploaded 2007-06-12	Available
YBS Supporting Statement A 060707.doc	Supporting Statement A	Uploaded 2007-06-12	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43617	Consent to Further Contact	Form and Instruction	Modified
180718	Yellowstone National Park Backcountry Survey [Paper Version]	Form and Instruction	New
180717	Yellowstone National Park Backcountry Survey [Web-based Version]	Form and Instruction	New

ICR Details

OMB Control No: 0920-0727	ICR Reference No: 200706-0920-011
Status: Historical Active	Previous ICR Reference No: 200604-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Survey of Illness and Injury Among Backcountry Users in Yellowstone National Park
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/23/2007
	Date Received in OIRA: 06/13/2007
Terms of Clearance: Approved consistent with revisions to the proposed survey methodology layed out in CDC memo submitted to OMB.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2009	12/31/2008	08/31/2007
Responses	13,670	0	5,276
Time Burden (Hours)	2,141	0	1,803
Cost Burden (Dollars)	0	0	0

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Abstract: CDC is collaborating with the National Park Service to conduct a public health survey designed to gather informaion to improve recommendations for safe and healthy backcountry travel. The survey will be conducted among Yellowstone National Park hikers regarding illness and injuries experienced while in the back country.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Pubilc Health Service 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:
	70 FR 62121	10/28/2005
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 32669	06/13/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Yellowstone National Park Backcountry Survey [Web-based Version]	None	Yellowstone National Park Backcountry Survey
Consent to Further Contact	None	Consent-to-Further-Contact Form
Yellowstone National Park Backcountry Survey [Paper Version]	None	Yellowstone National Park Backcountry Survey

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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	13,670	5,276	0	8,394	0	0
Annual Time Burden (Hours)	2,141	1,803	0	338	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: Yes

Burden Reduction Due to: Changing Forms

Short Statement: This Revision includes 1) a report on a preliminary pilot study conducted at the Sequoia and Kings Canyon National Parks [data collection in Fall 2006], and 2) plans for an expanded study to be conducted at Yellowstone National Park [data collection May-Dec 2008]. For the proposed expanded study, burden estimates for the primary data collection instrument (web and paper versions) have been increased as a result of experience gained in the pilot phase. However, the estimated burden for the initial contact form has been reduced due to a proposed reduction in the number of demographic elements. For additional information, please refer to the NOA dated September 19, 2006.

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Annual Cost to Federal Government: $70,365

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: 06/13/2007

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