Using Traditional Foods and Sustainable Ecological Approaches for Health Promotion and Diabetes Prevention in American Indian/Alaska Native Communities

Forms and Documents

Document Name	Status
Retrospective Data Collection Form	Modified
Traditional Foods Shared Data Elements Form	Modified
0920-0889 Change Request.docx Justification for No Material/Nonsubstantive Change	2012-10-25
Att 4c. Email with Link to SDE.doc Supplementary Document	2011-03-23
Att 4b. Partner Notification-Shared Data Elements.doc Supplementary Document	2011-03-23
Att 4b. Partner Notification-Shared Data Elements.doc Supplementary Document	2011-03-23
Att 4c. Email with Link to SDE.doc Supplementary Document	2011-03-23

IC Document Collections

IC ID	Document Title	Status
197196	Retrospective Data Collection Form	Modified
197195	Traditional Foods Shared Data Elements Form	Modified

ICR Details

OMB Control No: 0920-0889	ICR Reference No: 201210-0920-012
Status: Historical Active	Previous ICR Reference No: 201104-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Using Traditional Foods and Sustainable Ecological Approaches for Health Promotion and Diabetes Prevention in American Indian/Alaska Native Communities
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: Approved without change	Conclusion Date: 10/31/2012
	Date Received in OIRA: 10/26/2012
Terms of Clearance: Previous terms continue: Approved with the understanding that the data collected will not be used for program evaluation.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2014	06/30/2014	06/30/2014
Responses	40	0	40
Time Burden (Hours)	80	0	80
Cost Burden (Dollars)	0	0	0

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Abstract: CDC requests minor changes in the information collection instrument to clarify wording and to improve usability and respondent satisfaction.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
  

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? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Traditional Foods Shared Data Elements	none	Traditional Foods SDE Reporting
Retrospective Data Collection	none	Shared data elements - screen shots

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ICR Summary 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	40	40	0	0	0	0
Annual Time Burden (Hours)	80	80	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

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: $63,955

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: 10/26/2012

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