Healthcare System Surge Capacity at the Community Level

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Interview Protocol for Public Health Preparedness Coalition Leader	Form	Modified	Available
Interview Protocol for Emergency Department and Primary Care	Form	Modified	Available
Supporting Statement B.docx	Supporting Statement B	Uploaded 2011-05-04	Available
clean_Attachment J--Privacy of Data Agreement.doc	Supplementary Document	Uploaded 2011-05-04	Available
clean_Attachment I--Privacy of Data Pledge.docx	Supplementary Document	Uploaded 2011-05-04	Available
clean_Attachment I--Mathematica Privacy of Data Pledge.docx	Supplementary Document	Uploaded 2011-05-04	Available
surge 60 day.pdf	Supplementary Document	Uploaded 2011-05-04	Available
Attachment A Sec. 301 42 USC 241[1].pdf	Supplementary Document	Uploaded 2011-05-04	Available
clean_Attachment H--Thank-you Letter.doc	Supplementary Document	Uploaded 2011-05-04	Available
clean_Attachment F--Follow-up Letter.docx	Supplementary Document	Uploaded 2011-05-04	Available
clean_Attachment G--Confirmation Letter.doc	Supplementary Document	Uploaded 2011-05-04	Available
clean_Attachment E--Invitation Letter.docx	Supplementary Document	Uploaded 2011-05-04	Available
Supporting Statement A 3-9.docx	Supporting Statement A	Uploaded 2011-05-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
197250	Interview Protocol for Public Health Preparedness Coalition Leader	Form	Modified
197249	Interview Protocol for Emergency Department and Primary Care	Form	Modified

ICR Details

OMB Control No: 0920-0887	ICR Reference No: 201105-0920-002
Status: Historical Active	Previous ICR Reference No: 201104-0920-007
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Healthcare System Surge Capacity at the Community Level
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: 05/10/2011
	Date Received in OIRA: 05/05/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2012	12 Months From Approved
Responses	63	0	0
Time Burden (Hours)	63	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Healthcare Preparedness Activity in the Division of Healthcare Quality Promotion works with other federal agencies, state government, medical societies and organizations to promote collaboration among healthcare partners. The goal of this activity is to help local communities' healthcare delivery and public health sectors prepare for and respond to urgent and emergent threats. This project will explore barriers and facitlitators to coordination on surge response in 10 communities.

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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:
	76 FR 147	01/03/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 15315	03/21/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Interview Protocol for Emergency Department and Primary Care	none	Interview Protocol for ED and PC
Interview Protocol for Public Health Preparedness Coalition Leader	none	Protocol for PH Preparedness

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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	63	0	0	63	0	0
Annual Time Burden (Hours)	63	0	0	63	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: $183,119

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: 05/05/2011

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