Evaluation of the Action Plan for the National Public Health Initiative on Diabetes and Womens Health

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 2 Survey of Private Sector Partners	Form and Instruction	New	Available
Form 2 Survey of State-based Diabetes Prevention and Control Programs	Form and Instruction	New	Available
Form 1 Survey of Co-Sponsors	Form and Instruction	New	Available
Supporting Statement Part B.doc	Supporting Statement B	Uploaded 2009-11-12	Available
Attachment C NPHIDWH.pdf	Supplementary Document	Uploaded 2009-11-12	Available
Attachment B Federal Register Notice.pdf	Supplementary Document	Uploaded 2009-11-12	Available
Attachment A Authorizing Legislation.doc	Supplementary Document	Uploaded 2009-11-12	Available
Attachment D1 Partner Invitation.doc	Supplementary Document	Uploaded 2009-11-12	Available
Attachment D2 Partner Reminder.doc	Supplementary Document	Uploaded 2009-11-12	Available
Attachment D1 Partner Invitation.doc	Supplementary Document	Uploaded 2009-11-12	Available
Attachment D2 Partner Reminder.doc	Supplementary Document	Uploaded 2009-11-12	Available
Attachment E2 Cosponsor Reminder.doc	Supplementary Document	Uploaded 2009-11-12	Available
Attachment E1 Cosponsor Invitation.doc	Supplementary Document	Uploaded 2009-11-12	Available
Supporting Statement Part A.doc	Supporting Statement A	Uploaded 2009-11-12	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
191480	Survey of Private Sector Partners	Form and Instruction	New
191479	Survey of State-based Diabetes Prevention and Control Programs	Form and Instruction	New
191478	Survey of Co-Sponsors	Form and Instruction	New

ICR Details

OMB Control No: 0920-0839	ICR Reference No: 200912-0920-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluation of the Action Plan for the National Public Health Initiative on Diabetes and Womens Health
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: 01/14/2010
	Date Received in OIRA: 12/02/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2013	36 Months From Approved
Responses	132	0	0
Time Burden (Hours)	66	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC proposes to conduct a survey to assess progress toward achieving the objectives outlined in the National Public Health Initiative on Diabetes and Women's Health. Participation is voluntary. Respondents will be approximately 124 collaborating organizations that are doing work in areas targeting women with or at risk for diabetes, including states and organizations in the private-sector.

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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:
	73 FR 79490	12/29/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 59982	11/19/2009
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
Survey of State-based Diabetes Prevention and Control Programs	2	Survey of State-based Diabetes Prevention and Control Programs
Survey of Co-Sponsors	1	Survey of Co-Sponsors
Survey of Private Sector Partners	2	Survey of State-based Diabetes Prevention and Control Programs

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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	132	0	0	132	0	0
Annual Time Burden (Hours)	66	0	0	66	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 ICR submission.

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Annual Cost to Federal Government: $6,020

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? Yes

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: 12/02/2009

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