Tourette Syndrome National Education and Outreach Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Attachment 5 HIPoints Privacy Policy.pdf	Supplementary Document	Uploaded 2012-01-11	Available
Attachment 4 HIPoints Terms of Use.pdf	Supplementary Document	Uploaded 2012-01-11	Available
Attachment 3 HIPoints Terms Conditions.pdf	Supplementary Document	Uploaded 2012-01-11	Available
0920-0910_IC #1TV Rough Cuts 09 2012.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2012-01-11	Available
Reminder This Harris Poll Online Survey Is Still Open.mht	Supplementary Document	Uploaded 2012-01-11	Source copy available
New Harris Poll Online Survey.mht	Supplementary Document	Uploaded 2012-01-11	Source copy available
Att E Follow up Survey Invitation.docx	Supplementary Document	Uploaded 2011-08-05	Available
Att E Follow up Survey Invitation.docx	Supplementary Document	Uploaded 2011-08-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
200753	OSH Rough Cut Testing of TV Ads Main Questionnaire	Instruction	New
200752	OSH Rough Cut Testing of TV Ads Screener	Instruction	New
198886	Family Resource Dissemination	Other-WORD	Modified
198885	Family/Public Medical Program Evaluation	Other-WORD	Modified
198884	Family/Public Education Program Evaluation	Other-WORD	Modified
198883	Education Resource Dissemination	Other-WORD	Modified
198882	Education Program Post-test	Other-WORD	Modified
198881	Education Program Pre-Test	Other-WORD	Modified
198880	Education Program Evaluation	Other-WORD	Modified
198879	Medical Resource Dissemination	Other-WORD	Modified
198878	CBIT Program 3-month Follow-up	Other-WORD	Modified
198877	CBIT Online Program Evaluation	Other-WORD	Modified
198876	CBIT Post Test	Other-WORD	Modified
198875	CBIT Pre-test	Other-WORD	Modified
198874	CBIT Program Evaluation	Other-WORD	Modified
198873	Physician Training Retreat 3-Month Follow-up	Other-WORD	Modified
198872	Physician Training Retreat Post-test	Other-WORD	Modified
198871	Physician Training Retreat Pre-test	Other-WORD	Modified
198870	Medical Program Evaluation	Instruction	Modified

ICR Details

OMB Control No: 0920-0901	ICR Reference No: 201201-0920-005
Status: Historical Inactive	Previous ICR Reference No: 201108-0920-005
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Tourette Syndrome National Education and Outreach Program
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 01/12/2012
	Date Received in OIRA: 01/12/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2013	09/30/2013	09/30/2013
Responses	7,100	0	7,100
Time Burden (Hours)	277	0	277
Cost Burden (Dollars)	0	0	0

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Abstract: The National Center for Birth Defects and Developmental Disabilities will collect program evaluation data from participants of educational workshops and recipients of educational resources on Tourette Syndrome (TS) conducted by the Tourette Syndrome Association in a cooperative agreement with the CDC. Health education has been developed for three groups of audiences: Health professionals, education professionals, and people with TS and their families. The format includes general education programs for the three groups, as well as two more in-depth medical training programs for physicians on TS and on the Comprehensive Behavioral Intervention for Tics (CBIT) treatment.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: The Public Health and Welfare
  

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

Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 19

table that charts list of burden

IC Title	Form No.	Form Name
CBIT Pre-test
CBIT Post Test
CBIT Online Program Evaluation
CBIT Program 3-month Follow-up
Education Resource Dissemination
Education Program Post-test
CBIT Program Evaluation
Medical Program Evaluation
Physician Training Retreat Pre-test
Physician Training Retreat Post-test
Physician Training Retreat 3-Month Follow-up
Medical Resource Dissemination
Education Program Evaluation
Education Program Pre-Test
Family/Public Education Program Evaluation
Family/Public Medical Program Evaluation
Family Resource Dissemination
OSH Rough Cut Testing of TV Ads Screener
OSH Rough Cut Testing of TV Ads Main Questionnaire

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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:

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Annual Cost to Federal Government: $1,131,326

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: 01/12/2012

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