Evaluating Reach, Awareness, and Exposure of Enhanced Implementation of the Learn the Signs. Act Early. Campaign in Four Target Sites

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3F LTSAE ATT3F Post-Implementation Survey for Parents (Spanish) OMB	Form and Instruction	New	Available
Form 3E LTSAE ATT3E Post-Implementation Survey for Parents (English) OMB	Form and Instruction	New	Available
Form 5 A Post-Implementation Survey for Parents-English	Form and Instruction	New	Available
Form 6 A Post-Implementaion Survey for Parents-Spanish	Form and Instruction	New	Available
Form 3 Screener for Parents for Post Implemention Survey-English	Form	New	Available
Form 4 Screener for Parents for Post-Implementation Survey-Spanish	Form	New	Available
Form 3d LTSAE ATT3D Pre-Implementation Survey for Parents (Spanish) OMB	Form and Instruction	New	Available
Form 3c LTSAE ATT3C Pre-Implementation Survey for Parents (English) OMB	Form and Instruction	New	Available
Form 3 A Pre-Implementation Survey for Parents--English	Form and Instruction	New	Available
Form 4 A Pre-Implementation Survey for Parents--Spanish	Form and Instruction	New	Available
Form 2 Screener for Parents--Spanish 3B	Form	New	Available
Form 1 Screener for Parents--English 3A	Form	New	Available
LTSAE OMB -Supporting Statement Part B_FINAL.docx	Supporting Statement B	Uploaded 2012-01-04	Available
Att 1_Legislation.doc	Supplementary Document	Uploaded 2011-11-22	Available
FINAL_LTSAE OMB - Supporting Statement Part A (927).doc	Supporting Statement A	Uploaded 2012-01-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
200249	Post-Implementation Survey for Parents	Form and Instruction	New	LTSAE ATT3F Post-Implementation Survey for Parents (Spanish) OMB
200249	Post-Implementation Survey for Parents	Form and Instruction	New	LTSAE ATT3E Post-Implementation Survey for Parents (English) OMB
200249	Post-Implementation Survey for Parents	Form and Instruction	New	A Post-Implementation Survey for Parents-English
200249	Post-Implementation Survey for Parents	Form and Instruction	New	A Post-Implementaion Survey for Parents-Spanish
200248	Screener for Parents for Post-Implementation Survey	Form	New	Screener for Parents for Post Implemention Survey-English
200248	Screener for Parents for Post-Implementation Survey	Form	New	Screener for Parents for Post-Implementation Survey-Spanish
200247	Pre-Implementation Survey for Parents	Form and Instruction	New	LTSAE ATT3D Pre-Implementation Survey for Parents (Spanish) OMB
200247	Pre-Implementation Survey for Parents	Form and Instruction	New	LTSAE ATT3C Pre-Implementation Survey for Parents (English) OMB
200247	Pre-Implementation Survey for Parents	Form and Instruction	New	A Pre-Implementation Survey for Parents--English
200247	Pre-Implementation Survey for Parents	Form and Instruction	New	A Pre-Implementation Survey for Parents--Spanish
200246	Screener for Parents (English 3A), (Spanish 3B)	Form	New	Screener for Parents--Spanish 3B
200246	Screener for Parents (English 3A), (Spanish 3B)	Form	New	Screener for Parents--English 3A

ICR Details

OMB Control No: 0920-0911	ICR Reference No: 201111-0920-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluating Reach, Awareness, and Exposure of Enhanced Implementation of the Learn the Signs. Act Early. Campaign in Four Target Sites
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: 01/04/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/23/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2014	24 Months From Approved
Responses	4,400	0	0
Time Burden (Hours)	454	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: NCBDDD has funded four grantees to carry out an intensive implementation of the campaign in select target areas. This request for data collection is for the evaluation of the "Learn the Signs. Act Early." campaign to assess the reach of the intensive implementation of the "Learn the Signs, Act Early." campaign and to capture any change in awareness, knowledge, or behavior that may result among the intended audience.

---

Authorizing Statute(s): PL: Pub.L. 42 - 241 301 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 27325	05/11/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 70729	11/15/2011
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Post-Implementation Survey for Parents	6, 5, 3F, 3E	A Post-Implementaion Survey for Parents-Spanish ,   A Post-Implementation Survey for Parents-English ,   LTSAE ATT3E Post-Implementation Survey for Parents (English) OMB ,   LTSAE ATT3F Post-Implementation Survey for Parents (Spanish) OMB
Pre-Implementation Survey for Parents	3, 4, 3d, 3c	A Pre-Implementation Survey for Parents--English ,   A Pre-Implementation Survey for Parents--Spanish ,   LTSAE ATT3C Pre-Implementation Survey for Parents (English) OMB ,   LTSAE ATT3D Pre-Implementation Survey for Parents (Spanish) OMB
Screener for Parents (English 3A), (Spanish 3B)	1, 2	Screener for Parents--English 3A ,   Screener for Parents--Spanish 3B
Screener for Parents for Post-Implementation Survey	4, 3	Screener for Parents for Post-Implementation Survey-Spanish ,   Screener for Parents for Post Implemention Survey-English

---

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	4,400	0	0	4,400	0	0
Annual Time Burden (Hours)	454	0	0	454	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 ICR.

---

Annual Cost to Federal Government: $18,267

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

---

Common Form ICR:  No

---

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: 11/23/2011

---