Evaluation of the Successful Business Strategies to Prevent Heart Disease and Stroke Toolkit

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0920-07AL_Supporting Statement_Sect B_10 22 07.doc	Supporting Statement B	Uploaded 2007-10-23	Available
0920-07AL_Attachment 6_0801.doc	Supplementary Document	Uploaded 2007-10-23	Available
0920-07AL_Attachment 5_0801.doc	Supplementary Document	Uploaded 2007-10-23	Available
0920-07AL_Attachment 4_0801.doc	Supplementary Document	Uploaded 2007-10-23	Available
0920-07AL_Attachment 3_0801.doc	Supplementary Document	Uploaded 2007-10-23	Available
0920-07AL_Attachment 1_0801.doc	Supplementary Document	Uploaded 2007-10-23	Available
0920-07AL_Supporting Statement_Sect A_10 22 07.doc	Supporting Statement A	Uploaded 2007-10-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
182609	Evaluation of the Successful Business Strategies to Prevent Heart Disease and Stroke Toolkit	Other-Data Collection Instrument	New

ICR Details

OMB Control No: 0920-0764	ICR Reference No: 200711-0920-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluation of the Successful Business Strategies to Prevent Heart Disease and Stroke Toolkit
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: 02/15/2008
	Date Received in OIRA: 11/06/2007
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2009	12 Months From Approved
Responses	25	0	0
Time Burden (Hours)	13	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This project builds on previous work with CDC to develop a Business Toolkit for State Health Departments(SHDs) to use in their work with employers. The Successful Business Strategies to Prevent Heart Disease and Stroke Toolkit was designed to be used by the SHDs in their efforts with employers implementing worksite cardiovascular health promotion programs and purchasing preventive health benefits from health plans. For this project, we have trained SHDs to use the Toolkit, provided consultation services, and are evaluating the Toolkit's usefulness from the perspectives of the SHDs and employers. This data collection request is for to survey a representative of each SHD and the District of Columbia from the Heart Disease and Stroke Prevention program. The information gathered will be used to modify and improve the Toolkit and make it more useful for State Health Departments in their work with employers.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public 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:
	72 FR 4512	01/31/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 50371	08/31/2007
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Evaluation of the Successful Business Strategies to Prevent Heart Disease and Stroke Toolkit

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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	25	0	0	25	0	0
Annual Time Burden (Hours)	13	0	0	13	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 data collection.

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Annual Cost to Federal Government: $18,842

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: 11/06/2007

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