Community Transformation Grants: Evaluation of Nutrition, Physical Activity, and Obesity-related Television Media Campaigns

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Attachment 6b Health and Media Survey	Form and Instruction	New	Repair queued
Attachment 6a Health and Media Survey	Form and Instruction	New	Available
5b Welcome to the Health and Media Survey	Form and Instruction	New	Available
Welcome to the Health and Media Survey	Form and Instruction	New	Available
ICR.0920-12LR-CTG. Media Campaigns. Part B.CLEAN.docx	Supporting Statement B	Uploaded 2013-05-13	Available
Attachment 9_IRB Approval.pdf	Supplementary Document	Uploaded 2012-10-29	Available
Attachment 7_RN Recruitment Procedures.docx	Supplementary Document	Uploaded 2012-10-29	Available
Attachment 4_CTG Awardees.docx	Supplementary Document	Uploaded 2012-10-29	Available
Attachment 3_Strategic Directions.docx	Supplementary Document	Uploaded 2012-10-29	Available
Attachment 1d_PPHF.pdf	Supplementary Document	Uploaded 2012-10-29	Available
Attachment 1c_ACA.pdf	Supplementary Document	Uploaded 2012-10-29	Available
Attachment 1b_ARRA.pdf	Supplementary Document	Uploaded 2012-10-29	Available
Attachment 1a_PHSA.pdf	Supplementary Document	Uploaded 2012-10-29	Available
Attachment 8_Email Notification and Reminders.docx	Supplementary Document	Uploaded 2012-10-29	Available
ICR. 0920-12LR-CTG. Media Campaigns.Part A.CLEAN.docx	Supporting Statement A	Uploaded 2013-05-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
204661	Health and Media Survey	Form and Instruction	New	Attachment 6b Health and Media Survey
204661	Health and Media Survey	Form and Instruction	New	Attachment 6a Health and Media Survey
204660	Welcome to the Health and Media Survey	Form and Instruction	New	5b Welcome to the Health and Media Survey
204660	Welcome to the Health and Media Survey	Form and Instruction	New	Welcome to the Health and Media Survey

ICR Details

OMB Control No: 0920-0967	ICR Reference No: 201210-0920-013
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Community Transformation Grants: Evaluation of Nutrition, Physical Activity, and Obesity-related Television Media Campaigns
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 with change	Conclusion Date: 05/13/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/31/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2014	12 Months From Approved
Responses	41,064	0	0
Time Burden (Hours)	8,983	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC plans to conduct a web-based survey to evaluate nutrition, physical activity, and obesity related campaigns conducted as part of CDC's Community Transformation Grant program. The cross-sectional survey will be administered in areas where CTG awardees are conducting media campaigns and in two comparison samples.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Research and Investigations Generally
  

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 33462	06/06/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 65191	10/25/2012
Did the Agency receive public comments on this ICR? Yes

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

table that charts list of burden

IC Title	Form No.	Form Name
Health and Media Survey	None, None	Attachment 6a Health and Media Survey ,   Attachment 6b Health and Media Survey
Welcome to the Health and Media Survey	None, None	Welcome to the Health and Media Survey ,   5b Welcome to the Health and Media Survey

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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	41,064	0	0	41,064	0	0
Annual Time Burden (Hours)	8,983	0	0	8,983	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 new information collection necessary to support evaluation of ACA and ARRA funded activities.

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Annual Cost to Federal Government: $573,056

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: 10/31/2012

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