Children's Health after the Storms (CHATS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Mail Verification for Interview	Form	New	Available
Verification Questionnaire for Interview	Form	New	Available
Verification for Screener	Form	New	Available
Baseline - Session 2 Modules	Form and Instruction	New	Available
6-Month Follow-up - Session 2 Modules	Form and Instruction	New	Available
6 Month Follow-up - Session 1 Modules	Form and Instruction	New	Available
6 Month Follow-up - Session 1 Modules	Form and Instruction	New	Available
Baseline Session 2 Modules	Form and Instruction	New	Available
Baseline Session 2 Modules	Form and Instruction	New	Available
Baseline Session 1 Modules	Form and Instruction	New	Available
Baseline Session 1 Modules	Form and Instruction	New	Available
Eligibility Screener	Form	New	Available
CHATS Attachment X_revised_02272012.docx	Supplementary Document	Uploaded 2012-02-29	Available
CHATS Attachment W_revised_02272012.docx	Supplementary Document	Uploaded 2012-02-29	Available
CHATS Attachment V_revised_02272012.docx	Supplementary Document	Uploaded 2012-02-29	Available
CHATS Attachment O_revised_02272012.docx	Supplementary Document	Uploaded 2012-02-29	Available
CHATS Attachment N_revised_02272012.docx	Supplementary Document	Uploaded 2012-02-29	Available
CHATS Attachment M_revised_02272012.docx	Supplementary Document	Uploaded 2012-02-29	Available
CHATS Attachment L_revised_02272012.docx	Supplementary Document	Uploaded 2012-02-29	Available
CHATS Attachment J_revised_02272012.docx	Supplementary Document	Uploaded 2012-02-29	Available
CHATS Attachment I_revised_02272012.docx	Supplementary Document	Uploaded 2012-02-29	Available
CHATS Attachment H_revised_02272012.docx	Supplementary Document	Uploaded 2012-02-29	Available
CHATS Section B_revised_02272012.docx	Supporting Statement B	Uploaded 2012-02-29	Available
Draft 8 OMB ATTACHMENT B1_B2_Updated_30Aug11.docx	Supplementary Document	Uploaded 2011-08-31	Available
Incident Report Form.docx	Supplementary Document	Uploaded 2011-08-29	Available
Resource List.docx	Supplementary Document	Uploaded 2011-08-29	Available
Study Results.docx	Supplementary Document	Uploaded 2011-08-29	Available
Authorization Letters.docx	Supplementary Document	Uploaded 2011-08-29	Available
Other non-burden Instruments.docx	Supplementary Document	Uploaded 2011-08-29	Available
Draft 8 OMB Attachment G through I.docx	Supplementary Document	Uploaded 2011-08-29	Available
CHATS Attachment F_revised_02272012.docx	Supplementary Document	Uploaded 2012-02-29	Available
Attachment D Cash Receipt Form.docx	Supplementary Document	Uploaded 2011-08-29	Available
Attachment C 2 Website and FAQs Public.docx	Supplementary Document	Uploaded 2011-08-29	Available
CHATS Attachment C_revised_02272012.docx	Supplementary Document	Uploaded 2012-02-29	Available
CHATS Attachment E_revised_02272012.docx	Supplementary Document	Uploaded 2012-02-29	Available
Attachment B FRN.docx	Supplementary Document	Uploaded 2011-08-29	Available
Attachment A Legislation.docx	Supplementary Document	Uploaded 2011-08-29	Available
CHATS Section A_revised_02272012.docx	Supporting Statement A	Uploaded 2012-02-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
199172	Mail Verification Form for Baseline and 6-Month Fllow-up Visits (1% subsample)	Form	New	Mail Verification for Interview
199171	Verification Questionnaire for Baseline and 6-Month Follow-up Visits (9% subsample)	Form	New	Verification Questionnaire for Interview
199170	Verification Quesionnaire for Eligibility Screener (10% subsample)	Form	New	Verification for Screener
199169	6-Month Follow-up: Session 2 (Parent Modules)	Form and Instruction	New	Baseline - Session 2 Modules
199168	6-Month Follow-up: Session 2 (Child Modules)	Form and Instruction	New	6-Month Follow-up - Session 2 Modules
199167	6-Month Follow-up: Session 1 (Parent Modules)	Form and Instruction	New	6 Month Follow-up - Session 1 Modules
199166	6-Month Follow-up: Session 1 (Child Modules)	Form and Instruction	New	6 Month Follow-up - Session 1 Modules
199165	Baseline: Session 2 (Parent Modules)	Form and Instruction	New	Baseline Session 2 Modules
199164	Baseline: Session 2 (Child Modules)	Form and Instruction	New	Baseline Session 2 Modules
199163	Baseline: Session 1 (Parent Modules)	Form and Instruction	New	Baseline Session 1 Modules
199162	Baseline: Session 1 (Child Modules)	Form and Instruction	New	Baseline Session 1 Modules
199161	Eligibillity Screener	Form	New	Eligibility Screener

ICR Details

OMB Control No: 0920-0925	ICR Reference No: 201109-0920-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Children's Health after the Storms (CHATS)
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: 03/08/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/08/2011
Terms of Clearance: Clearance is provided consistent with the understanding that this collection is designed to examine the feasibility of conducting a more robust study. Because this collection is not statistically rigorous enough to characterize the existence, size, or nature of the relationships between health outcomes and exposures, CDC has stated that they will not share underlying data outside of the agency and neither CDC nor its collaborators will disseminate the results of any analyses of the relationships between health outcomes and exposure. Upon submission of the next phase of this study to OMB, CDC will fully characterize the results of each of the methodological objectives described in the current collection.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2015	36 Months From Approved
Responses	3,178	0	0
Time Burden (Hours)	1,310	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Disease Control and Prevention requests approval to study the potential long-term health effects of various indoor exposures among children who resided in Federal Emergency Management Agency (FEMA)-provided Temporary Housing Units (THUs), who represent a vulnerable population in areas affected by hurricanes Katrina and Rita.

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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:
	75 FR 70006	11/16/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 55393	09/07/2011
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
6-Month Follow-up: Session 1 (Parent Modules)	none	6 Month Follow-up - Session 1 Modules
6-Month Follow-up: Session 1 (Child Modules)	none	6 Month Follow-up - Session 1 Modules
6-Month Follow-up: Session 2 (Child Modules)	none	6-Month Follow-up - Session 2 Modules
6-Month Follow-up: Session 2 (Parent Modules)	none	Baseline - Session 2 Modules
Baseline: Session 1 (Child Modules)	none	Baseline Session 1 Modules
Baseline: Session 1 (Parent Modules)	none	Baseline Session 1 Modules
Baseline: Session 2 (Child Modules)	none	Baseline Session 2 Modules
Baseline: Session 2 (Parent Modules)	none	Baseline Session 2 Modules
Eligibillity Screener	none	Eligibility Screener
Mail Verification Form for Baseline and 6-Month Fllow-up Visits (1% subsample)	none	Mail Verification for Interview
Verification Quesionnaire for Eligibility Screener (10% subsample)	none	Verification for Screener
Verification Questionnaire for Baseline and 6-Month Follow-up Visits (9% subsample)	none	Verification Questionnaire for Interview

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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	3,178	0	0	3,178	0	0
Annual Time Burden (Hours)	1,310	0	0	1,310	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.

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Annual Cost to Federal Government: $5,701,501

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: 09/08/2011

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