Evaluation of the Communities Putting Prevention to Work (CPPW) National Prevention Media Initiative

Forms and Documents

Document Name	Status
Community Telephone Interview (complete) Form	New
Community Telephone Interview (incomplete) Form	New
Screener for the Community Telephone Interview Form	New
SS Part B_08 03 2012.docx Supporting Statement B	2012-08-27
Att 3_MAPPS Intervention Table.pdf Supplementary Document	2012-08-27
Att 2b_Summary of Public Comments.doc Supplementary Document	2012-08-27
Att 2a_60-day FRN 5 23 2012.pdf Supplementary Document	2012-08-27
Att 1c_ACA.pdf Supplementary Document	2012-08-27
Att 1b_ARRA.pdf Supplementary Document	2012-08-27
Att 1a_PHSA.doc Supplementary Document	2012-08-27
SS Part A_08 17 2012.docx Supporting Statement A	2012-08-27

IC Document Collections

IC ID	Document Title	Status
203872	Community Telephone Interview (complete) Form	New
203871	Community Telephone Interview (incomplete) Form	New
203870	Screener for the Community Telephone Interview Form	New

ICR Details

OMB Control No:	ICR Reference No: 201208-0920-007
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluation of the Communities Putting Prevention to Work (CPPW) National Prevention Media Initiative
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 12/12/2012
	Date Received in OIRA: 08/27/2012
Terms of Clearance: Withdrawn at the request of the Agency.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		12 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC plans to collect information to support evaluation of the national prevention media initiative. Evaluation efforts will focus on 39 communities with obesity-related media activities related to the Communities Putting Prevention to Work (CPPW) initiative.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 4002 Name of Law: ACA
   US Code: 42 USC 301 Name of Law: PHSA
   PL: Pub.L. 111 - 5 VIII Name of Law: ARRA
  

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:
	77 FR 30535	05/23/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 51807	08/27/2012
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Screener for the Community Telephone Interview	none	Screener
Community Telephone Interview (incomplete)	none	Telephone Interview
Community Telephone Interview (complete)	none	Telephone Interview

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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: CDC plans to conduct 2 cycles of information collection in Fall 2012 and Winter/Spring 2012-13 to evaluate local media campaigns that address obesity in communities funded through the CPPW program.

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Annual Cost to Federal Government: $611,731

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]? Yes

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)? Yes

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: 08/27/2012

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