The Green Housing Study

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Time / Activity Form - for Mothers / Primary Caregivers	Form	New	Available
Illness Checklist	Form	New	Available
Time / Activity Form - for Children	Form	New	Available
Six and Twelve Month Follow-up Questionnaire - for Children	Form	New	Available
Six and Twelve Month Follow-up Questionnaire - for Environment	Form	New	Available
Three and Nine Month Phone Contact	Form	New	Available
Baseline Questionnaire for Children	Form	New	Available
Baseline Questionnaire - Demographics	Form	New	Available
Baseline Questionnaire Part 2 - Home Characteristics	Form	New	Available
Baseline Questionnaire - Home Characteristics	Form	New	Available
Screening Questionnaire	Form	New	Available
NEW APPENDIX_H_New since July. 2011 ICR Submission_Recruitment flyer.doc	Supplementary Document	Uploaded 2011-11-09	Available
REVISED_Green Housing Study ICR Part B_October 20. 2011.doc	Supporting Statement B	Uploaded 2011-11-09	Available
Appendix G -Assent Form (17-11).doc	Supplementary Document	Uploaded 2011-07-07	Available
REVISED_APPENDIX_F_Consent Form_ October 20. 2011.doc	Supplementary Document	Uploaded 2011-11-09	Available
Appendix E (IRB Approval letter) 6-8-2011.doc	Supplementary Document	Uploaded 2011-07-07	Available
Appendix C (Public comment from February 3, 2010).doc	Supplementary Document	Uploaded 2011-07-07	Available
Appendix B (60 Day Federal Register Notice FRN).doc	Supplementary Document	Uploaded 2011-07-07	Available
Appendix A (Authorizing Legislation and Other Relevant Laws).doc	Supplementary Document	Uploaded 2011-07-07	Available
REVISED_Green Housing Study ICR_ Part A_October 20.2011.doc	Supporting Statement A	Uploaded 2011-11-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
198577	Time / Activity Form - for Mothers / Primary Caregivers	Form	New
198576	Illness Checklist	Form	New
198575	Time / Activity Form - for Children	Form	New
198574	Six and Twelve Month Follow-up Questionnaire - for Children	Form	New
198573	Six and Twelve Month Follow-up Questionnaire - for Environment	Form	New
198572	Three and Nine Month Phone Contact	Form	New
198571	Monthly Text Messages	Other-Text Messages	New
198570	Baseline Questionnaire for Children	Form	New
198569	Baseline Questionnaire - Demographics	Form	New
198568	Baseline Questionnaire Part 2 - Home Characteristics	Form	New
198567	Baseline Questionnaire - Home Characteristics	Form	New
198566	Screening Questionnaire	Form	New

ICR Details

OMB Control No: 0920-0906	ICR Reference No: 201107-0920-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: The Green Housing Study
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 with change	Conclusion Date: 11/17/2011
	Date Received in OIRA: 07/20/2011
Terms of Clearance: Approval is given contengent on the understanding that CDC will submit a non-substantive change request to OMB via ROCIS before fielding translated instruments or any site-specific variations on the protocol, consent forms, or recuitment materials developed locally. Similarly, all changes to the questionnaires must be submitted to OMB.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2014	36 Months From Approved
Responses	25,960	0	0
Time Burden (Hours)	2,356	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The efficacy of green building design features in reducing allergens and toxic substances within the home has been assumed based on conventional wisdom. A better understanding is needed of the extent to which green-built, low-income housing actually reduces exposures to these compounds when compared to control homes.

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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 5596	02/03/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 41260	07/13/2011
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 12

table that charts list of burden

IC Title	Form No.	Form Name
Time / Activity Form - for Mothers / Primary Caregivers	N/A	Time Activity (Mother-Primary Caregiver)
Illness Checklist	none	Illness Checklist
Three and Nine Month Phone Contact	none	3 and 9 Month Follow-up
Six and Twelve Month Follow-up Questionnaire - for Environment	none	6 and 12 month Follow-up - Environment
Six and Twelve Month Follow-up Questionnaire - for Children	none	6 and 12 month Follow-up Children
Time / Activity Form - for Children	none	Time / Activity - Children
Screening Questionnaire	none	Screening Questionnaire
Baseline Questionnaire - Home Characteristics	N/A	Baseline (Home Characteristics)
Baseline Questionnaire Part 2 - Home Characteristics	N/A	Baseline Questionnaire (Home Characteristics) Part 2
Baseline Questionnaire - Demographics	none	Baseline Questionnaire (Demographics)
Baseline Questionnaire for Children	none	Baseline Questionnaire Children
Monthly Text Messages

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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	25,960	0	0	25,960	0	0
Annual Time Burden (Hours)	2,356	0	0	2,356	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 data collection request.

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Annual Cost to Federal Government: $648,000

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: 07/20/2011

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