Case Studies of Selected Communities and States Funded under Community Activities under the Communities Putting Prevention to Work (CPPW) Initiative

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Interview Guide for Policy Makers	Form	New	Available
Att 10 - Interview Guide for Policy Makers	Form	New	Available
Att 9 - Guide for Community Partners	Form	New	Available
Att 9 - Interview Guide for Community Partners	Form	New	Available
Att 11 - Worksheet for Scheduling Interviews	Form	New	Available
Att 8 - Interview Guide for Staff	Form	New	Available
Att 8 - Interview Guide for Management Staff	Form	New	Available
Interview Planning Tool	Form	New	Available
Table Summary of CPPW Evaluation 01 06 2011.doc	Supplementary Document	Uploaded 2011-01-06	Available
CPPW Case Study SS Part B_FINAL 01 06 2011.docx	Supporting Statement B	Uploaded 2011-01-06	Available
Attachment 1c ACA PL 111-148 Section 4002.pdf	Supplementary Document	Uploaded 2010-10-28	Available
Attachment 14 Candidate communities.doc	Supplementary Document	Uploaded 2010-10-22	Available
Attachment 13 Oral Informed Consent Script.doc	Supplementary Document	Uploaded 2010-10-22	Available
Attachment 12 RTI CPPW Case Study Non-Disclosure Agreement.doc	Supplementary Document	Uploaded 2010-10-22	Available
Attachment 6 ARRA-Funded CPPW States, Territories and the District of Columbia.pdf	Supplementary Document	Uploaded 2010-10-22	Available
Attachment 5 MAPPS Strategies and References.pdf	Supplementary Document	Uploaded 2010-10-22	Available
Attachment 4 Affordable Care Act Funded Communities.pdf	Supplementary Document	Uploaded 2010-10-22	Available
Attachment 3 ARRA Funded CPPW Communities.pdf	Supplementary Document	Uploaded 2010-10-22	Available
Attachment 2b Summary of Public Comments.doc	Supplementary Document	Uploaded 2010-10-22	Available
Attachment 2a Federal Register Notice.pdf	Supplementary Document	Uploaded 2010-10-22	Available
Attachment 1b ARRA of 2009.pdf	Supplementary Document	Uploaded 2010-10-22	Available
Attachment 1a. Public Health Service Act.doc	Supplementary Document	Uploaded 2010-10-22	Available
Attachment 7e Site Visit Preparatory Call.doc	Supplementary Document	Uploaded 2010-10-22	Available
Attachment 7d Introductory e-mail to schedule site visit preparatory call.doc	Supplementary Document	Uploaded 2010-10-22	Available
Attachment 7b CPPW Case Study Introductory Letter.doc	Supplementary Document	Uploaded 2010-10-22	Available
Attachment 7c Case Study FAQs for CPPW-Affordable Care Act Sites.doc	Supplementary Document	Uploaded 2010-10-22	Available
CPPW Case Study SS Part A_FINAL 01 06 2011.doc	Supporting Statement A	Uploaded 2011-01-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
195057	Policy and Decision Makers Interview, Private Sector	Form	New	Interview Guide for Policy Makers
195056	Policy and Decision Makers Interview, State and Local Government Sector	Form	New	Att 10 - Interview Guide for Policy Makers
195055	Community Partners Interview, Private Sector	Form	New	Att 9 - Guide for Community Partners
195054	Community Partners Interview, State and Local Government Sector	Form	New	Att 9 - Interview Guide for Community Partners
195053	Interview Planning Worksheet	Form	New	Att 11 - Worksheet for Scheduling Interviews
195052	CPPW Staff Interview	Form	New	Att 8 - Interview Guide for Staff
195051	CPPW Management Interview	Form	New	Att 8 - Interview Guide for Management Staff
195050	Interview Planning Tool	Form	New	Interview Planning Tool

ICR Details

OMB Control No: 0920-0876	ICR Reference No: 201010-0920-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Case Studies of Selected Communities and States Funded under Community Activities under the Communities Putting Prevention to Work (CPPW) Initiative
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 with change	Conclusion Date: 01/17/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/29/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2013	24 Months From Approved
Responses	528	0	0
Time Burden (Hours)	678	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC proposes to conduct case studies of selected CPPW states and communities to gain insight into the factors that facilitate or hinder the implementation of MAPPS strategies for improving nutrition and physical activity, and decreasing the prevalence of obesity and tobacco use. Information will be collected at personal interviews conducted at each case study site.

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Authorizing Statute(s): PL: Pub.L. 111 - 5 VIII Name of Law: American Recovery and Reinvestment Act of 2009
   US Code: 42 USC 241 Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 148 4002 Name of Law: Patient Protection and Affordable Care 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:
	75 FR 11184	03/10/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 65355	10/22/2010
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
CPPW Management Interview	none	Att 8 - Interview Guide for Management Staff
CPPW Staff Interview	none	Att 8 - Interview Guide for Staff
Community Partners Interview, Private Sector	none	Att 9 - Guide for Community Partners
Community Partners Interview, State and Local Government Sector	none	Att 9 - Interview Guide for Community Partners
Interview Planning Tool	none	Interview Planning Tool
Interview Planning Worksheet	none	Att 11 - Worksheet for Scheduling Interviews
Policy and Decision Makers Interview, Private Sector	none	Interview Guide for Policy Makers
Policy and Decision Makers Interview, State and Local Government Sector	none	Att 10 - Interview Guide for Policy Makers

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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	528	0	0	528	0	0
Annual Time Burden (Hours)	678	0	0	678	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 required as part of a comprehensive evaluation of Communities Putting Prevention to Work, a ARRA funded initiative.

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Annual Cost to Federal Government: $1,571,528

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]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 10/29/2010

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