Communities Putting Prevention to Work

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3 Supplemental Funding for Healthy Communities, Tobacco Control, Diabetes Prevention and Control and Behavioral Risk Factor Surveillance	Form and Instruction	New	Available
0920-XXXX Communities Putting Prevention to Work 9 14 2009 version 2.doc	Supporting Statement A	Uploaded 2009-09-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
190673	Supplemental Funding for Healthy Communities, Tobacco Control, Diabetes Prevention and Control and Behavioral Risk Factor Surveillance	Form and Instruction	New
190672	Application for Community Approaches to Chronic Disease Prevention and Control	Other-Application	New
190671	LOI for Community Approaches to Chronic Disease Prevention and Control	Other-Letter of Intent	New

ICR Details

OMB Control No: 0920-0820	ICR Reference No: 200909-0920-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Communities Putting Prevention to Work
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 09/15/2009
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/14/2009
	Date Received in OIRA: 09/14/2009
Terms of Clearance: If the program wishes to maintain approval for this package beyond the initial 3 month approval, a 60-day notice followed by a 30-day notice will be published in the federal register and a package will be submitted for OMB approval under the standard process.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2009	3 Months From Approved
Responses	531	0	0
Time Burden (Hours)	12,780	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Disease Control and Prevention (CDC) seeks approval to support intensive community approaches to chronic disease prevention and control in selected communities to achieve prevention outcomes related to increased physical activity, improved nutrition, decreased overweight/obesity prevalence, decreased smoking prevalence and teen smoking initiation; and decreased exposure to secondhand smoke.

Emergency Justfication: An emergency clearance is requested based on the time-sensitive nature of activities to be funded through this ARRA clearance.

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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

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
LOI for Community Approaches to Chronic Disease Prevention and Control
Application for Community Approaches to Chronic Disease Prevention and Control
Supplemental Funding for Healthy Communities, Tobacco Control, Diabetes Prevention and Control and Behavioral Risk Factor Surveillance	3	Supplemental Funds Application

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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	531	0	0	531	0	0
Annual Time Burden (Hours)	12,780	0	0	12,780	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: $222,667

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)? Yes

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: 09/14/2009

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