Measuring Preferences for Quality of Life for Child Maltreatment

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Quality of Life Survey	Form	New	Repair queued
Supporting_Statement_B.docx	Supporting Statement B	Uploaded 2011-09-26	Repair queued
Attachment_G_IRB_approval.docx	Supplementary Document	Uploaded 2011-09-26	Repair queued
Attachment_F_IRB-Consent-Form.docx	Supplementary Document	Uploaded 2011-09-26	Repair queued
Attachment_B_Published 60 Day FRN.pdf	Supplementary Document	Uploaded 2011-09-26	Repair queued
Attachment_A_PHS_act.docx	Supplementary Document	Uploaded 2011-09-26	Repair queued
Attachment_C_Survey-Invitation.docx	Supplementary Document	Uploaded 2011-09-27	Repair queued
Supporting_Statement_A 9-13-11.docx	Supporting Statement A	Uploaded 2011-09-26	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
199632	Quality of Life Survey	Form	New

ICR Details

OMB Control No:	ICR Reference No: 201110-0920-001
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Measuring Preferences for Quality of Life for Child Maltreatment
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: Improperly submitted	Conclusion Date: 12/15/2011
	Date Received in OIRA: 10/03/2011
Terms of Clearance: In accordance with 5 CFR 1320, the information collection is not approved at this time and is being returned to CDC as improperly submitted. Prior to the approval of this collection, the agency should provide OMB with the following in their resubmission of the proposed ICR: - A review of similar efforts made by other agencies, an explanation of how this collection is different and why this collection is necessary - A detailed explanation of how valid results will be obtained using the methodology and questions outlined in this ICR packet - Clarification of the collection’s design and utility (concentrate on the utility of the questions being used in the questionnaire and the scales that will be created based on respondents’ answers to these questions) - Provide a clear outline of the agency’s objectives/research questions - Provide further details of the study sampling methodology and the agency’s plans to address to non-response bias

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: The Centers for Disease Control and Prevention has developed an exploratory survey instrument to quantify the Health-Related Quality-of-Life (HRQOL) impacts resulting from child maltreatment, using a quantitative, preference-based approach.

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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 67092	11/01/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 60497	09/29/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Quality of Life Survey	none	Quality of Life 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 data collection.

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Annual Cost to Federal Government: $182,189

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: 10/03/2011

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