Improving the Quality and Delivery of CDC's Heart Disease and Stroke Prevention Programs

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Screenshots for Living a Balanced Life with Diabetes Assessment Survey	Form and Instruction	New	Available
Assessing Adoption and Use of the Living a Balanced Life with Diabetes Toolkit	Form and Instruction	New	Available
Att 4 - Survey 2	Form	New	Available
Att 2 - Survey 1	Form	New	Available
Year 4 Evaluation Survey part II	Form and Instruction	New	Available
Year 4 Evaluation Survey part I	Form and Instruction	New	Available
Survey to Assess Adoption and Use of IOM Report on Hypertension	Form	New	Available
Assessing Community-Clinical Linkages	Form	New	Available
DHDSP Newsletters Survey	Form	New	Available
Year 3 Evaluation Survey Part III	Form	New	Available
Year 3 Evaluation Survey Part II	Form	New	Available
Year 3 Evaluation Survey Part I	Form	New	Available
Supporting Statement B - 5.07.10.doc	Supporting Statement B	Uploaded 2010-06-24	Available
Non-Research Determination.pdf	Supplementary Document	Uploaded 2010-06-24	Available
Attachment 3-DHDSP Evaluation Plan.pdf	Supplementary Document	Uploaded 2010-06-24	Available
Attachment 2B-Summary of Public Comments.doc	Supplementary Document	Uploaded 2010-06-24	Available
Attachment 2A-Federal Register Notice.pdf	Supplementary Document	Uploaded 2010-06-24	Available
Attachment 1-Authorizing Legislation.doc	Supplementary Document	Uploaded 2010-06-24	Available
Att_5d_IC_2-Follow-Up_Email050710.docx	Supplementary Document	Uploaded 2010-07-12	Available
Att_5c_IC_2-Advance_Notice_Email0507010.docx	Supplementary Document	Uploaded 2010-07-12	Available
Att_5a_IC_2-Overview050710.docx	Supplementary Document	Uploaded 2010-07-12	Available
Att 4d_IC 1_Follow-Up Email.doc	Supplementary Document	Uploaded 2010-07-12	Available
Att 4c_IC 1_Advance Notice Email.doc	Supplementary Document	Uploaded 2010-07-12	Available
Att 4a_IC 1_Overview.doc	Supplementary Document	Uploaded 2010-07-12	Available
Supporting Statement A - 5.07.10.doc	Supporting Statement A	Uploaded 2010-07-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
208194	Assessing Adoption and the Living a Balanced Life With Diabetes Tookit	Form and Instruction	New	Screenshots for Living a Balanced Life with Diabetes Assessment Survey
208194	Assessing Adoption and the Living a Balanced Life With Diabetes Tookit	Form and Instruction	New	Assessing Adoption and Use of the Living a Balanced Life with Diabetes Toolkit
206050	Evaluation of Physical Activity and Public Health Training Courses for Research and Practitioners	Other-WORD	New
204537	Assessing Adoption and Use of Steps to Wellness: A Guide to Implementing the 2008 Physical Activity Guidelines for Americans in the Workplace	Form	New	Att 4 - Survey 2
204537	Assessing Adoption and Use of Steps to Wellness: A Guide to Implementing the 2008 Physical Activity Guidelines for Americans in the Workplace	Form	New	Att 2 - Survey 1
202746	Assessing Programmatic Efforts and Technical Assistance Needs	Form and Instruction	New	Year 4 Evaluation Survey part II
202746	Assessing Programmatic Efforts and Technical Assistance Needs	Form and Instruction	New	Year 4 Evaluation Survey part I
200854	Web-based Survey to Improve the Quality and Effectiveness of CDC's Technical Assistance and Resources Promoting Adoption of IOM Hypertension Recommendations for States	Form	New	Survey to Assess Adoption and Use of IOM Report on Hypertension
200759	Assessing State Programs' Community-Clinical Linkages and Related Technical Assistance Needs	Form	New	Assessing Community-Clinical Linkages
198401	DHDSP Newletters: Assessing Usage, Usefulness and Access	Form	New	DHDSP Newsletters Survey
196993	Assessing programmatic efforts and technical assistance needs of WISEWOMAN	Form	New	Year 3 Evaluation Survey Part III
196993	Assessing programmatic efforts and technical assistance needs of WISEWOMAN	Form	New	Year 3 Evaluation Survey Part II
196993	Assessing programmatic efforts and technical assistance needs of WISEWOMAN	Form	New	Year 3 Evaluation Survey Part I
194197	Survey on Sodium Awareness	Other-Web Survey	New
194196	Survey on Hypertension	Other-Web Survey	New

ICR Details

OMB Control No: 0920-0864	ICR Reference No: 201008-0920-003
Status: Historical Active	Previous ICR Reference No: 200906-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Improving the Quality and Delivery of CDC's Heart Disease and Stroke Prevention Programs
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: 09/19/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/10/2010
Terms of Clearance: Approved consistent with the following terms of clearance: For each information collection, a GenIC information collection request will be prepared and submitted to OMB for review and approval. Any changes to the ICR will also be submitted to OMB for review and approval.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2013	36 Months From Approved
Responses	2,928	0	0
Time Burden (Hours)	2,169	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC's Division of Heart Disease and Stroke Prevention proposes to collect information from key partners in state and local health departments, the private sector, and academic institutions in order to evaluate the relevance, quality and impact of DHDSP services and programs, and to improve services and programs. A generic clearance is requested in order to provide flexibility.

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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 75721	12/12/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 39261	07/08/2010
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
Assessing Adoption and Use of Steps to Wellness: A Guide to Implementing the 2008 Physical Activity Guidelines for Americans in the Workplace	none, none	Att 2 - Survey 1 ,   Att 4 - Survey 2
Assessing Adoption and the Living a Balanced Life With Diabetes Tookit	None, None	Assessing Adoption and Use of the Living a Balanced Life with Diabetes Toolkit ,   Screenshots for Living a Balanced Life with Diabetes Assessment Survey
Assessing Programmatic Efforts and Technical Assistance Needs	none, none	Year 4 Evaluation Survey part I ,   Year 4 Evaluation Survey part II
Assessing State Programs' Community-Clinical Linkages and Related Technical Assistance Needs	none	Assessing Community-Clinical Linkages
Assessing programmatic efforts and technical assistance needs of WISEWOMAN	none, none, none	Year 3 Evaluation Survey Part I ,   Year 3 Evaluation Survey Part II ,   Year 3 Evaluation Survey Part III
DHDSP Newletters: Assessing Usage, Usefulness and Access	none	DHDSP Newsletters Survey
Evaluation of Physical Activity and Public Health Training Courses for Research and Practitioners
Survey on Hypertension
Survey on Sodium Awareness
Web-based Survey to Improve the Quality and Effectiveness of CDC's Technical Assistance and Resources Promoting Adoption of IOM Hypertension Recommendations for States	none	Survey to Assess Adoption and Use of IOM Report on Hypertension

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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	2,928	0	0	2,928	0	0
Annual Time Burden (Hours)	2,169	0	0	2,169	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 generic data collection, that was previously retracted by OMB for changes.

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Annual Cost to Federal Government: $74,376

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]? No

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: 08/10/2010

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