National Survey of Primary Care Policies for Managing Patients with High Blood Pressure, High Cholesterol, or Diabetes

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
National Survey of Primary Care Policies for Managing Patients with High Blood Pressure, High Cholesterol, or Diabetes	Form	New	Repair queued
NSPCP Screener	Form	New	Repair queued
Cognitive Testing for the NSPCP	Form and Instruction	New	Repair queued
Part B NSPCP DRAFT 7-19-11.docx	Supporting Statement B	Uploaded 2011-07-25	Repair queued
Attachment 8_Technical Appendix 7-19-11.docx	Supplementary Document	Uploaded 2011-07-25	Repair queued
Attachment 7b_Westat IRB amendment approval.pdf	Supplementary Document	Uploaded 2011-07-25	Repair queued
Attachment 7a_Westat IRB approval letter 7-19-11.pdf	Supplementary Document	Uploaded 2011-07-25	Repair queued
Attachment 6_Westat employee confidentiality pledge.pdf	Supplementary Document	Uploaded 2011-07-25	Repair queued
Attachment 2b - Summary of Public Comments.docx	Supplementary Document	Uploaded 2011-07-25	Repair queued
Attachment 2a_FRN 04 29 2011.pdf	Supplementary Document	Uploaded 2011-07-25	Repair queued
Attachment 1_Authorizing Legislation.doc	Supplementary Document	Uploaded 2011-07-25	Repair queued
Attachment 5c_Reminder Letters.docx	Supplementary Document	Uploaded 2011-07-25	Repair queued
Attachment 5b_Invitation letter Draft 7-19-11.doc	Supplementary Document	Uploaded 2011-07-25	Repair queued
Attachment 3b_Cog Testing Consent Form.docx	Supplementary Document	Uploaded 2011-07-25	Repair queued
Part A NSPCP DRAFT 7-19-11.docx	Supporting Statement A	Uploaded 2011-07-25	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
198726	National Survey of Primary Care Policies for Managing Patients with High Blood Pressure, High Cholesterol, or Diabetes	Form	New
198725	NSPCP Screener	Form	New
198724	Cognitive Testing for the NSPCP	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 201108-0920-001
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Survey of Primary Care Policies for Managing Patients with High Blood Pressure, High Cholesterol, or Diabetes
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 12/13/2011
	Date Received in OIRA: 08/02/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC plans to conduct this survey to examine the use of evidence-based systems, multidisciplinary team approaches for chronic disease treatment, electronic health records, and patient follow-upmechnisms. Respondents will be primary care physician practices. The survey will be repeated two years after baseline.

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Authorizing Statute(s): US Code: 42 USC 301 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 24029	04/29/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 45256	07/28/2011
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
National Survey of Primary Care Policies for Managing Patients with High Blood Pressure, High Cholesterol, or Diabetes	none	National Survey of Primary Care Policies
NSPCP Screener	none	Screener
Cognitive Testing for the NSPCP	none	Cognitive Interview Intro and Guide: Survey

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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: $135,180

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: 08/02/2011

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