Let's Move in Indian Country - School Survey

Forms and Documents

Document Name	Status
Form 1076-0XXX Survey Questions Form and Instruction	New
Signed Emergency Justification.pdf Supplementary Document	2011-01-27
Signed Emergency Justification.pdf Supplementary Document	2011-01-26
SS-A for LMIC Survey 1 26.doc Supporting Statement A	2011-01-26
SS-B for LMIC Survey 1 24.doc Supporting Statement B	2011-01-24
Emergency Justification.docx Supplementary Document	2011-01-21

IC Document Collections

IC ID	Document Title	Status
196009	Survey Questions Form and Instruction	New

ICR Details

OMB Control No: 1076-0175	ICR Reference No: 201101-1076-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOI/BIA	Agency Tracking No:
Title: Let's Move in Indian Country - School 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: 01/25/2011
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/27/2011
	Date Received in OIRA: 01/25/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2011	6 Months From Approved
Responses	284	0	0
Time Burden (Hours)	284	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: An interagency collaboration between the First Lady’s Let’s Move! Initiative, the Departments of the Interior (AS-IA, Bureau of Indian Affairs, and Bureau of Indian Education), Agriculture, Health and Human Services (IHS), and Education has been formed to reduce disproportionately high obesity rates and improve the health of Native youth. This survey is designed to determine what resources are already available at schools in Indian Country and those serving significant populations of Native youth and more importantly what further resources are needed in order to create healthy school environments for all of students.

Emergency Justfication: The Let’s Move in Indian Country School Survey will be administered to Bureau of Indian Education schools, Tribal schools, and public schools serving high populations of Native students. The survey is time sensitive since it is our first step in a 3-month process to develop the framework for the Let’s Move in Indian Country Initiative, with an anticipated launch date of mid-March. The survey is intended to serve as a vehicle to assess the needs of particular school sites related to health, nutrition, and physical activity programs, services, and infrastructure. The survey will therefore help us establish a baseline of activity and infrastructure at the school sites rather than help to develop policy recommendations. Conducting a needs assessment and determining baseline information is necessary in order for us to identify areas of need and opportunities for successful models to ensure efficient and effective use of government resources. The broader Let’s Move in Indian Country Initiative is facilitating several collaborative efforts with Tribes and Tribal leaders providing ample opportunities for comment and input on the Initiative as it is developed, including goals and strategies for implementation.

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Authorizing Statute(s): US Code: 25 USC 2 Name of Law: Commissioner of Indian Affairs Duties
  

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

IC Title	Form No.	Form Name
Survey Questions	1076-0XXX	Let's Move! Indian Country - School Survey

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ICR Summary 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	284	0	0	284	0	0
Annual Time Burden (Hours)	284	0	0	284	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 one-time survey of schools serving high populations of Native Americans, to establish a baseline of activity and infrastructure in support of an interagency collaboration, Let’s Move in Indian Country, to reduce disproportionately high obesity rates and improve the health of Native youth.

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Annual Cost to Federal Government: $110,834

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]? No

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: 01/25/2011

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