National Survey of Prison Health Care (NSPHC)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
National Survey of Prison Health Care Interview Guide	Form	New	Available
NSPHC Supporting Statement Part B CLEAN.doc	Supporting Statement B	Uploaded 2012-05-16	Available
Attachment G ERB Exemption Approval Form.pdf	Supplementary Document	Uploaded 2012-05-16	Available
Attachment E NSPHC Introduction Letter.docx	Supplementary Document	Uploaded 2012-05-16	Available
Attachment D Public Comments for 60-day Notice.docx	Supplementary Document	Uploaded 2012-05-16	Available
Attachment C Copy of Official 60-day Notice.pdf	Supplementary Document	Uploaded 2012-05-16	Available
Attachment B Expert Meeting Attendees.docx	Supplementary Document	Uploaded 2012-05-16	Available
Attachment A Legislative Authority FINAL.docx	Supplementary Document	Uploaded 2012-05-16	Available
NSPHC Supporting Statement Part A CLEAN.docx	Supporting Statement A	Uploaded 2012-05-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202389	National Survey of Prison Health Care Interview Guide	Form	New

ICR Details

OMB Control No: 0920-0935	ICR Reference No: 201205-0920-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Survey of Prison Health Care (NSPHC)
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 without change	Conclusion Date: 06/01/2012
	Date Received in OIRA: 05/21/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2014	12 Months From Approved
Responses	51	0	0
Time Burden (Hours)	204	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The National Survey of Prison Health Care (NSPHC) will be a semi-structured telephone survey with a prison official in the Department of Corrections (DOC) in the 50 States and Federal Bureau of Prisons (BOP) and will seek facility-level information on the types of healthcare services delivered and the mechanisms used to deliver them. The goals of this survey include to: Collect data that will provide an overall picture of the structure of U.S. prison health care delivery systems; and assess the quality of the data collected. NSPHC will collect data on how DOCs maintain health records including the format (paper and/or electronic) of specific types of health records.

---

Authorizing Statute(s): US Code: 42 USC 242k Name of Law: National Center for Health Statistics
  

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 17420	03/29/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 75885	12/05/2011
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
National Survey of Prison Health Care Interview Guide	none	NSPHC Interview Guide

---

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	51	0	0	51	0	0
Annual Time Burden (Hours)	204	0	0	204	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: $299,400

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: 05/21/2012

---