Evaluation of Core Violence and Injury Prevention Program

Forms and Documents

Document Name	Status
Supplemental SOTS Survey Questions Form	New
Form 4 Core VIPP Non-Funded SHD: SOTS Financial Module Form and Instruction	Modified
Form 3 Core VIPP Funded SHD: SOTS Financial Module Form and Instruction	Modified
Form 2 Core VIPP Non-funded State Health Department State of the States Survey Form and Instruction	Modified
Form 1 Core VIPP Funded State Health Department--State of the States Survey Form and Instruction	Modified
Change Justification Memo.docx Justification for No Material/Nonsubstantive Change	2013-02-13
Attachment F-SOTS Supplement.docx Supplementary Document	2013-02-13

IC Document Collections

IC ID	Document Title	Status
205808	Supplemental SOTS Survey Questions Form	New
200347	Core VIPP Non-Funded SHD: SOTS Financial Module Form and Instruction	Modified
200346	Core VIPP Funded SHD: SOTS Financial Module Form and Instruction	Modified
200345	Core VIPP Funded SHD: Telephone Interview Other-Telephone interview questions for Core VIPP Evaluation	Modified
200344	Core VIPP Non-funded State Health Department State of the States Survey Form and Instruction	Modified
200343	Core VIPP Funded State Health Department--State of the States Survey Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0916	ICR Reference No: 201302-0920-012
Status: Historical Active	Previous ICR Reference No: 201112-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No: 18809
Title: Evaluation of Core Violence and Injury Prevention Program
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 with change	Conclusion Date: 02/15/2013
	Date Received in OIRA: 02/14/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2014	01/31/2014	01/31/2014
Responses	156	0	128
Time Burden (Hours)	284	0	242
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC is requesting a non-substantive change to this approved data collection which will allow more effective assessments for this program. The purpose of this ICR is to permit CDC to evaluate the Core VIPP program for the benefit of the Core VIPP grantees. This ICR has two overall goals: (1) to assess state injury and violence prevention plans for completeness, measurability, and effectiveness; and (2) evaluate the effectiveness of the Core VIPP cooperative agreement. Through the evaluation of the Core VIPP, CDC plans to improve state health department program and policy activities. The ultimate goal of the Core VIPP is to assist State Health Departments (SHDs) to build and/or maintain effective delivery systems for dissemination, implementation and evaluation of best practice programs and policies. This includes support for general capacity building of SHDs and their local partners, as well as strategy specific capacity building for the implementation of direct best practice interventions (older adult falls and child injury).

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: The Public Health and Welfare
  

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

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Core VIPP Funded State Health Department--State of the States Survey	1	State of the States Survey in PDF format
Core VIPP Non-funded State Health Department State of the States Survey	2	State of the States Survey in Word Format
Core VIPP Funded SHD: Telephone Interview
Core VIPP Funded SHD: SOTS Financial Module	3	Core VIPP Funded SHD: SOTS Financial Module
Core VIPP Non-Funded SHD: SOTS Financial Module	4	Core VIPP Non-Funded SHD: SOTS Financial Module
Supplemental SOTS Survey Questions	none	Mock-up Screen Shots Supplement SOTS Survey

---

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	156	128	0	28	0	0
Annual Time Burden (Hours)	284	242	0	42	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 justification for change is submitted because CDC has developed new questions as a supplement to the State of the State Survey (SOTS) for year two of data collection. This new module contains questions designed to assess state injury violence prevention plans for completeness, measurability, and effectiveness. This change results in a minor increase in burden hours and does not change the scope of the evaluation.

---

Annual Cost to Federal Government: $425,399

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: 02/14/2013

---