Centers for Disease Control and Prevention Performance Evaluation Program for Mycobacterium Tuberculosis/Non-tuberculosis Mycobacteria Drug Susceptibility Testing Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Laboratory Information Change	Form	Modified	Available
Enrollment form	Form	Modified	Available
Results Worksheet - revised 5/2011	Form	Modified	Available
Revised Results Worksheet	Form	Modified	Available
Results Worksheet	Form	Modified	Available
Laboratory practices questionnaire	Form	Modified	Source copy available
0920 0600 Justification change request_2011_0504.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2011-05-09	Available
0920-0600 Attachment 3c Acceptance Letter Template.doc	Supplementary Document	Uploaded 2009-12-16	Available
0920-0600 Attachment 3b Program Description.doc	Supplementary Document	Uploaded 2009-12-16	Available
0920-0600 Attachment 4g Aggregate Results Letter.doc	Supplementary Document	Uploaded 2009-12-16	Available
0920-0600 Attachment 4f Prelim Results Letter.doc	Supplementary Document	Uploaded 2009-12-16	Available
0920-0600 Attachment 4eii Phone Script.doc	Supplementary Document	Uploaded 2009-12-16	Available
0920-0600 Attachment 4ei Reminder Email.doc	Supplementary Document	Uploaded 2009-12-16	Available
0920-0600 Attachment 4b Shipment and Password Letter.doc	Supplementary Document	Uploaded 2009-12-16	Repair queued
0920-0600 Attachment 4a Pre-Shipment Letter.doc	Supplementary Document	Uploaded 2009-12-16	Available
0920-0600 Attachment 4d NTM Case History Form.doc	Supplementary Document	Uploaded 2009-12-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7065	MPEP for M.TB and non--tuberculous Mycobacteria Drug Susceptibility Testing Laboratory Information Change	Form	Modified	Laboratory Information Change
46481	MPEP for M. TB and non-tuberculous Mycobacteria Drug Susceptibility Testing Enrollment Form	Form	Modified	Enrollment form
46480	MPEP for M. TB and non-tuberculous Mycobacteria Drug Susceptibility Testing Results Worksheet	Form	Modified	Results Worksheet - revised 5/2011
46480	MPEP for M. TB and non-tuberculous Mycobacteria Drug Susceptibility Testing Results Worksheet	Form	Modified	Revised Results Worksheet
46480	MPEP for M. TB and non-tuberculous Mycobacteria Drug Susceptibility Testing Results Worksheet	Form	Modified	Results Worksheet
192388	MPEP for M. TB and non-tuberculous Mycobacteria Drug Susceptibility Testing Laboratory Practices Questionnaire	Form	Modified	Laboratory practices questionnaire

ICR Details

OMB Control No: 0920-0600	ICR Reference No: 201105-0920-008
Status: Historical Active	Previous ICR Reference No: 201010-0920-008
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Centers for Disease Control and Prevention Performance Evaluation Program for Mycobacterium Tuberculosis/Non-tuberculosis Mycobacteria Drug Susceptibility Testing Program
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/16/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/13/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2013	05/31/2013	05/31/2013
Responses	338	0	338
Time Burden (Hours)	167	0	167
Cost Burden (Dollars)	0	0	0

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Abstract: The CDC Model Performance Evaluation Program for Mycobacterium tuberculosis and Non-tuberculous Mycobacterium Drug Susceptibility Testing assesses the capability of domestic laboratories in detecting drug resistance in M.tuberculosis and non-tuberculous agents of human infection. This revsion reinstates the Laboratory Practices Questionnaire, and deletes all hardcopy forms. Foreign labs no longer participate in the program.

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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: 4

table that charts list of burden

IC Title	Form No.	Form Name
MPEP for M. TB and non-tuberculous Mycobacteria Drug Susceptibility Testing Enrollment Form	none	Enrollment form
MPEP for M. TB and non-tuberculous Mycobacteria Drug Susceptibility Testing Laboratory Practices Questionnaire	none	Laboratory practices questionnaire
MPEP for M. TB and non-tuberculous Mycobacteria Drug Susceptibility Testing Results Worksheet	none, none, none	Results Worksheet ,   Revised Results Worksheet ,   Results Worksheet - revised 5/2011
MPEP for M.TB and non--tuberculous Mycobacteria Drug Susceptibility Testing Laboratory Information Change	none	Laboratory Information Change

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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	338	338	0	0	0	0
Annual Time Burden (Hours)	167	167	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $244,495

Does this IC contain surveys, censuses, or employ statistical methods? No

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]? 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: 05/13/2011

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