The Evaluation of the Smoke Alarm Installation and Fire Safety Education (SAIFE) Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Get Alarmed North Carolina! Screener	Form	Modified	Available
Form 3 Get Alarmed North Carolina! Household visit	Form and Instruction	New	Available
Form 2 Get Alarmed North Carolina! 6-month pre-intervention telephone survey - Pre/Post Evaluation Survey	Form and Instruction	New	Available
Part B Supporting Statement_SAIFE.8-24-09.doc	Supporting Statement B	Uploaded 2009-08-27	Available
Appendix G - Information Letter.doc	Supplementary Document	Uploaded 2009-08-27	Available
Appendix F2 - Post-Intervention Home Visit Notification Letter.doc	Supplementary Document	Uploaded 2009-08-27	Available
Appendix C.pdf	Supplementary Document	Uploaded 2009-08-27	Available
Appendix F1 - Post-Intervention Survey Notification Letter.doc	Supplementary Document	Uploaded 2009-08-27	Available
Part A Supporting Statement- 8-24-09.doc	Supporting Statement A	Uploaded 2009-08-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43619	The Evaluation of the Smoke Alarm Installation and Fire Safety Education (SAIFE) Program	Form	Modified	Get Alarmed North Carolina! Screener
190629	Get Alarmed North Carolina! Household visit	Form and Instruction	New	Get Alarmed North Carolina! Household visit
190628	Get Alarmed North Carolina! 6-month pre-intervention telephone survey - Pre/Post Evaluation Survey	Form and Instruction	New	Get Alarmed North Carolina! 6-month pre-intervention telephone survey - Pre/Post Evaluation Survey

ICR Details

OMB Control No: 0920-0730	ICR Reference No: 200909-0920-002
Status: Historical Active	Previous ICR Reference No: 200605-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: The Evaluation of the Smoke Alarm Installation and Fire Safety Education (SAIFE) Program
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/09/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/11/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2012	36 Months From Approved	10/31/2009
Responses	1,181	0	1,181
Time Burden (Hours)	251	0	251
Cost Burden (Dollars)	0	0	0

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Abstract: This project seeks a one year extension of its OMB PRA clearance for data collection. Due to early project delays in obtaining clearances for data collection, the project was unable to start as planned and missed evaluating one program cycle, with a program cycle running for approximately one year. This extension is necessary in order to complete the projects original design of evaluating three program cycles of the SAIFE program as implemented in the State of North Carolina. An extension will allow completion of the evaluation of the third and final cycle of the program. This project will use data from in-person interviews, paper and telephone surveys to assess the effectiveness of the Smoke Alarm Installation and Fire Safety Education (SAIFE) program and its efficacy in delivering fire safety information. The data will be collected from a convenience sample of adults 18 years of age or older who volunteer to participate in the SAIFE program. A total of 360 households will complete the evaluation each year of the data collection for a mass total of 1080 households over the next three years. Participants will be asked to complete a 15-minute survey at two points, once immediately before the intervention and then 6 months afterwards. The survey will assess outcome measures including, but not limited to, changes in knowledge, attitudes, beliefs, and behaviors regarding various aspects of fire safety and prevention; changes in reported residential fire-related injuries and deaths; increased or decreased presence of functioning smoke alarms; and the costs associated with the SAIFE intervention. The evaluation will measure these changes across time, between groups and within groups, among communities that will receive the SAIFE intervention.

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Authorizing Statute(s): US Code: 3 USC 301 Name of Law: General Powers and Duties of Public Health Service Part A--Research and Investigations
  

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:
	74 FR 27323	06/09/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 45214	09/01/2009
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
Get Alarmed North Carolina! 6-month pre-intervention telephone survey - Pre/Post Evaluation Survey	2	Get Alarmed North Carolina! 6-month pre-intervention telephone survey - Pre/Post Evaluation Survey
Get Alarmed North Carolina! Household visit	3	Get Alarmed North Carolina! Household visit
The Evaluation of the Smoke Alarm Installation and Fire Safety Education (SAIFE) Program	1	Get Alarmed North Carolina! Screener

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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	1,181	1,181	0	0	0	0
Annual Time Burden (Hours)	251	251	0	0	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: Miscellaneous Actions

Short Statement: This is an extension of a currently approved ICR.

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Annual Cost to Federal Government: $257,297

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)? No

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: 09/11/2009

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