Evaluation of U.S. Family Planning Guidelines - Phase II

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Survey of non-Title X Clinic Administrators	Form	New	Repair queued
Survey of Title X Clinic Administrators	Form	New	Available
Survey of non-Title X Clinic Providers	Form	New	Available
Survey of Title X Clinic Providers	Form	New	Available
Survey of Office-based Physicians in the Private Sector	Form	New	Repair queued
0920-12HN SS Part B_8 20 2012.docx	Supporting Statement B	Uploaded 2012-08-22	Available
G3_Follow Up Letter_Administrator Survey.doc	Supplementary Document	Uploaded 2012-08-22	Available
G2_Follow Up Letter_Provider Survey(Public).doc	Supplementary Document	Uploaded 2012-08-22	Repair queued
G1_Follow Up Letter_Provider Survey(Private).doc	Supplementary Document	Uploaded 2012-08-22	Available
F3_Reminder Postcard_Public Sector Administrators.doc	Supplementary Document	Uploaded 2012-08-20	Repair queued
F2_Reminder Postcard_Public Sector Providers.doc	Supplementary Document	Uploaded 2012-08-20	Available
F1_Reminder Postcard_Private Sector.doc	Supplementary Document	Uploaded 2012-08-20	Available
B-2_Summary of Public Comments.docx	Supplementary Document	Uploaded 2012-08-20	Repair queued
B-1_60-day FRN.pdf	Supplementary Document	Uploaded 2012-08-20	Available
A_Public Health Service Act.docx	Supplementary Document	Uploaded 2012-08-20	Available
E2_Administrator Survey Cover Sheet.docx	Supplementary Document	Uploaded 2012-08-20	Repair queued
E2_Administrator Survey Cover Sheet.docx	Supplementary Document	Uploaded 2012-08-20	Repair queued
D2_Provider Survey Cover Sheet.doc	Supplementary Document	Uploaded 2012-08-22	Available
C2_Public Sector Cover Letter.doc	Supplementary Document	Uploaded 2012-08-22	Repair queued
C2_Public Sector Cover Letter.doc	Supplementary Document	Uploaded 2012-08-22	Repair queued
D2_Provider Survey Cover Sheet.doc	Supplementary Document	Uploaded 2012-08-22	Repair queued
C1_Private Sector Cover Letter.doc	Supplementary Document	Uploaded 2012-08-22	Available
D2_Provider Survey Cover Sheet.doc	Supplementary Document	Uploaded 2012-08-22	Available
0920-12HN SS Part A_8 20 2012.docx	Supporting Statement A	Uploaded 2012-08-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
203904	Survey of non-Title X Clinic Administrators	Form	New
203903	Survey of Title X Clinic Administrators	Form	New
203902	Survey of non-Title X Clinic Providers	Form	New
203901	Survey of Title X Clinic Providers	Form	New
203900	Survey of Office-based Physicians in the Private Sector	Form	New

ICR Details

OMB Control No: 0920-0969	ICR Reference No: 201208-0920-008
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluation of U.S. Family Planning Guidelines - Phase II
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: 11/19/2012
	Date Received in OIRA: 08/29/2012
Terms of Clearance:

table that charts list comparision

	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

---

Abstract: CDC plans to conduct surveys to assess diffusion, uptake and impact of 3 family planning guidance documents. Respondents will be health care partners in the private and public sectors, as well as administrators in Title X and Non-Title X clinics.

---

Authorizing Statute(s): US Code: 42 USC 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:
	77 FR 21101	04/09/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 50695	08/22/2012
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Survey of Office-based Physicians in the Private Sector	none	Survey of Health Care Providers
Survey of Title X Clinic Providers	none	Survey of Health Care Providers
Survey of non-Title X Clinic Providers	none	Survey of Health Care Providers
Survey of Title X Clinic Administrators	none	Survey for Administrators of Publicly-funded Health Centers that Provide Family Planning Services
Survey of non-Title X Clinic Administrators	none	Survey of Administrators of Publicly-funded Health Centers that Provide Family Planning Services

---

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: Phase I data collection was conducted in 2009 under 0920-0008. This ICR will support phase II data collection in Fall 2012 and Winter/Spring 2013. This request does not incorporate a planned follow-up data collection in approximately 3 years.

---

Annual Cost to Federal Government: $1,286,788

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

---

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: 08/29/2012

---