Survey of 911 Emergency Treatment for Heart Disease and Stroke

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form No number Topic Guide for Semi-Structured Telephone Interview	Form	New	Available
Form No number Local EMS Provider Survey	Form	New	Repair queued
Form No number Screening Script to Identify Supervisors for Interview	Form	New	Available
Att_G IRB Approval.doc	Supplementary Document	Uploaded 2008-01-09	Repair queued
Att_ E-2 Consent Semi-Structured Interview.doc	Supplementary Document	Uploaded 2008-01-09	Available
Att_ E-1 Follow-Up Message.doc	Supplementary Document	Uploaded 2008-01-09	Available
Att_B 60-day Federal Register Notice.doc	Supplementary Document	Uploaded 2008-01-09	Available
Att_A Authorizing Legislation.doc	Supplementary Document	Uploaded 2008-01-09	Available
Supporting Statement A-B 12 31 07.doc	Supporting Statement A	Uploaded 2008-01-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
183636	Topic Guide for Semi-Structured Telephone Interview	Form	New
183635	Local EMS Provider Survey	Form	New
183634	Screening Script to Identify Supervisors for Interview	Form	New

ICR Details

OMB Control No: 0920-0782	ICR Reference No: 200801-0920-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Survey of 911 Emergency Treatment for Heart Disease and Stroke
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: 06/30/2008
	Date Received in OIRA: 01/31/2008
Terms of Clearance: Approved consistent with the following terms of clearance: approved for purposes of conducting exploratory EMS research. CDC aknowledges that the results of the survey will not be nationally generalizable.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2009	12 Months From Approved
Responses	4,060	0	0
Time Burden (Hours)	533	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Disease Control and Prevention (CDC) has a responsibility to monitor and reduce death and disability due to heart disease and stroke, and needs information to work with partners and stakeholders to improve pre-hospital emergency treatment protocols and performance. The survey will collect information from approximately 2,250 local EMS departments, focusing on standards of emergency care, treatment protocols, administrative oversight, training, certification, and other service characteristics.

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Authorizing Statute(s): US Code: 42 USC 241 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 5297	02/05/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 2256	01/14/2008
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
Screening Script to Identify Supervisors for Interview	No number	Attachment C - Screening Script to Identify Supervisor
Local EMS Provider Survey	No number	Attachment D - Local EMS Provider Survey
Topic Guide for Semi-Structured Telephone Interview	No number	Attachment F - Topic Guide for Semi-Structured Telephone Interview

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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	4,060	0	0	4,060	0	0
Annual Time Burden (Hours)	533	0	0	533	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: $424,672

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: 01/31/2008

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