Division of Behavioral Surveillance (DBS) Gulf States Population Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Gulf States Population Survey	Form	New	Available
DBS GSPS SS Part B 3-02-11.docx	Supporting Statement B	Uploaded 2011-03-03	Available
GSPS 60-day FRN.pdf	Supplementary Document	Uploaded 2011-03-03	Available
42 USC 241.pdf	Supplementary Document	Uploaded 2011-03-03	Available
DBS GSPS SS Part A 3-02-11.docx	Supporting Statement A	Uploaded 2011-03-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
197081	Gulf States Population Survey	Form	New

ICR Details

OMB Control No: 0920-0885	ICR Reference No: 201103-0920-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Division of Behavioral Surveillance (DBS) Gulf States Population Survey
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: 04/29/2011
	Date Received in OIRA: 03/26/2011
Terms of Clearance: OMB is approving the broadening of the sampling frame to cover the entire state to allow more stable comparisons with other state-wide BRFSS data. This approval is granted consistent with CDC’s acknowledgement that comparisons between affected and unaffected parts of a given state may not be sufficiently powered and may be significantly confounded, thus limiting the utility of such an analysis. Any changes to the questionnaire, sampling frame, or other aspects of the study design or implementation should be submitted to OMB, consistent with the Paperwork Reduction Act.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2012	12 Months From Approved
Responses	40,000	0	0
Time Burden (Hours)	20,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: On April 20, 2010 the BP Deepwater Horizon oil rig exploded in the Gulf of Mexico spilling more than 4.9 billion gallons of oil into the Gulf. An ongoing public health concern is the effect of the spill on mental and behavioral health of populations around the Gulf region and mental health services needs. On October 7, 2010 OMB granted emergency clearance, #0920-0868, exp. April 30, 2011, to CDC's Public Health Surveillance Office to conduct a survey to monitor the mental and behavioral health status of this affected population. Using the Behavioral Risk Factor Surveillance System, the Division of Behavioral Surveillance implemented a survey to monitor mental and behavioral health variables in the adult popuation in selected coastal counties affected by the oil spill. Data collection began December 14, 2010 and will continue monthly for one year. This new ICR is to cover the portion of the data collection not covered by the emergency clearance.

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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
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 80056	12/21/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 12964	03/09/2011
Did the Agency receive public comments on this ICR? Yes

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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
Gulf States Population Survey	none	Gulf States Population Survey

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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	40,000	0	0	40,000	0	0
Annual Time Burden (Hours)	20,000	0	0	20,000	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 new ICR.

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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]? 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: 03/26/2011

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