Preventive Health and Health Services Block Grant

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
SS Part B_0106.May 2011.docx	Supporting Statement B	Uploaded 2011-06-01	Available
Attach 3 List of FY 2011 Awardees.docx	Supplementary Document	Uploaded 2011-06-01	Repair queued
Attach 2 FRN.docx	Supplementary Document	Uploaded 2011-06-01	Repair queued
Attach 1B PL102-531.pdf	Supplementary Document	Uploaded 2011-06-01	Available
Attach 1A 42 USC 300w 300w8.doc	Supplementary Document	Uploaded 2011-06-01	Repair queued
Attach 1C 45 CFR 96.pdf	Supplementary Document	Uploaded 2011-06-01	Available
Attach 5C Annual Report Guidance Updates.docx	Supplementary Document	Uploaded 2011-06-01	Repair queued
Attach 5B Annual Report Guidance.doc	Supplementary Document	Uploaded 2011-06-01	Available
Attach 4B Work Plan Guidance.doc	Supplementary Document	Uploaded 2011-06-01	Available
Attach 4C Work Plan Guidance Updates.docx	Supplementary Document	Uploaded 2011-06-01	Available
SS Part A_0106.May 2011.docx	Supporting Statement A	Uploaded 2011-06-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6636	PHHS Block Grant Management Information System (BG-MIS) Work Plan	Other-WORD	Modified
184866	PHHS Block Grant Management Information System (BG-MIS) Annual Report	Other-WORD	Modified

ICR Details

OMB Control No: 0920-0106	ICR Reference No: 201106-0920-006
Status: Historical Active	Previous ICR Reference No: 200805-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Preventive Health and Health Services Block Grant
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/24/2011
	Date Received in OIRA: 06/08/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2013	24 Months From Approved	08/31/2011
Responses	122	0	122
Time Burden (Hours)	2,135	0	3,355
Cost Burden (Dollars)	0	0	0

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Abstract: CDC currently provides Block Grant funding to 61 states, territories and tribal organizations, and collections Work Plans and Annual Reports to monitor their progress toward meeting Healthy People objectives, and to provide technical assistance. CDC requests OMB approval to continue information collection for two years. Information will be collected using a web-based MIS.

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Authorizing Statute(s): PL: Pub.L. 102 - 531 101-104 Name of Law: Preventive Health and health Services Block Grant
   US Code: 42 USC 300w-300w-8 Name of Law: Preventive Health and Health Services Block Grants
   US Code: 45 USC 96.1-96.17 Name of Law: Block Grants
  

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 12739	03/08/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 32212	06/03/2011
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
PHHS Block Grant Management Information System (BG-MIS) Work Plan
PHHS Block Grant Management Information System (BG-MIS) Annual Report

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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	122	122	0	0	0	0
Annual Time Burden (Hours)	2,135	3,355	0	-1,220	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: Yes

Burden Reduction Due to: Using Information Technology

Short Statement: This is a Revision of a currently approved collection. Informaton is entered into an electronic MIS, previous entries are used to pre-populate fields. Users only need to enter changes, therefore, the MIS results decreased burden to respondents.

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Annual Cost to Federal Government: $365,910

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]? 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: 06/08/2011

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