DBS Gulf Coast Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form no number DBS Gulf Coast Survey - BRFSS Stand Alone	Form	New	Available
DBS Gulf Coast Survey SS Part B.docx	Supporting Statement B	Uploaded 2010-10-06	Available
42 USC 241.pdf	Supplementary Document	Uploaded 2010-10-06	Available
DBS Guld Coast Survey SS Part A.doc	Supporting Statement A	Uploaded 2010-10-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
194809	DBS Gulf Coast Survey - BRFSS Stand Alone	Form	New

ICR Details

OMB Control No: 0920-0868	ICR Reference No: 201010-0920-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: DBS Gulf Coast Survey
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: 10/07/2010
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/07/2010
	Date Received in OIRA: 10/06/2010
Terms of Clearance: Because the data collection will be carried out over 12 months, CDC will go through the standard notice and comment process in order to obtain approval for the portion of this collection (6 months) that is not covered by the emergency approval.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2011	6 Months From Approved
Responses	30,000	0	0
Time Burden (Hours)	15,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: On April 21, 2010, the Deep Water Horizon oil drilling rig (owned by British Petroleum (BP)) caught fire and sank leading to oil spilling from the sea floor. The lives and livelihoods of persons residing in coastal communities have been impacted by this event due to loss of work, changes in patterns of leisure activities, and the effect on the physical environments in which they live. Preliminary data suggest that residents of gulf coast states, and particularly residents within coastal counties, are reporting higher levels of health risk behaviors and lower levels of self-assessment of health than in the previous year. Among the most significant health issues caused by this spill are the emotional and behavioral health effects on the populations in proximity to the Gulf region.

Emergency Justfication: The Gulf Coast Survey will be used to assist CDC, federal, state and local stakeholders evaluate changes in health risk behaviors of persons impacted by the recent Deep Water Horizon oil spill.

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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: 1

table that charts list of burden

IC Title	Form No.	Form Name
DBS Gulf Coast Survey - BRFSS Stand Alone	no number	BRFSS Stand Alone

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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	30,000	0	0	30,000	0	0
Annual Time Burden (Hours)	15,000	0	0	15,000	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 request for emergency clearance.

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Annual Cost to Federal Government: $3,000,000

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: 10/06/2010

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