Monitoring Changes in Attitudes and Practices among Family Planning Providers and Clinics

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Administrator Survey Screenshots	Form	Modified	Available
Survey of Adminstrators of Publicly-Funded Health Centers that Provide Family Planning Services	Form	Modified	Available
Administrator Survey Screenshots	Form	Modified	Repair queued
Survey of Administrators of Publicly-funded Health Centers that Provide Family Planning Services	Form	Modified	Available
Provider Survery Screenshots	Form	Modified	Available
Survey of Health Care Providers	Form	Modified	Repair queued
Provider Survey Screenshots	Form	Modified	Available
Survey of Health Care Providers	Form	Modified	Repair queued
Provider Survey Screenshots	Form	Modified	Available
Survey of Health Care Providers	Form	Modified	Available
SOW_FINAL_Phase 1.pdf	Supplementary Document	Uploaded 2013-05-16	Available
0920-12HN SS Part B_05 13_2013_clean version.docx	Supporting Statement B	Uploaded 2013-05-16	Available
Call for EPI AID_Phase 1.pdf	Supplementary Document	Uploaded 2013-02-28	Available
DRH Response to OMB Comments Dated 10312012_NOV 2012_rev FEB 25 2013.docx	Supplementary Document	Uploaded 2013-02-28	Available
Emergency Epidemic Investigations OMB Form_EPI-AID 2010-24.pdf	Supplementary Document	Uploaded 2013-02-28	Available
G3_Follow Up Letter_Administrator Survey_02_13_13.doc	Supplementary Document	Uploaded 2013-02-27	Repair queued
G2_Follow Up Letter_Provider Survey(Public)_02_13_13.doc	Supplementary Document	Uploaded 2013-02-27	Repair queued
G1_Follow Up Letter_Provider Survey(Private)_02_13_13.doc	Supplementary Document	Uploaded 2013-02-27	Available
F3_Reminder Postcard_Public Sector Administrators_02_13_13.doc	Supplementary Document	Uploaded 2013-02-27	Available
F2_Reminder Postcard_Public Sector Providers_02_13_13.doc	Supplementary Document	Uploaded 2013-02-27	Available
F1_Reminder Postcard_Private Sector_02_13_13.doc	Supplementary Document	Uploaded 2013-02-27	Available
B-2_Summary of Public Comments.docx	Supplementary Document	Uploaded 2013-02-27	Available
B-1_60-day FRN.pdf	Supplementary Document	Uploaded 2013-02-27	Available
E2_Administrator Survey Cover Sheet_02_13_13.docx	Supplementary Document	Uploaded 2013-02-28	Repair queued
C2_Public Sector Cover Letter_02_13_13.doc	Supplementary Document	Uploaded 2013-02-28	Available
E2_Administrator Survey Cover Sheet_02_13_13.docx	Supplementary Document	Uploaded 2013-02-28	Repair queued
D2_Provider Survey Cover Sheet_02_13_13.doc	Supplementary Document	Uploaded 2013-02-28	Repair queued
C1_Private Sector Cover Letter_02_13_2013.doc	Supplementary Document	Uploaded 2013-02-28	Available
D2_Provider Survey Cover Sheet_02_13_13.doc	Supplementary Document	Uploaded 2013-02-28	Available
C2_Public Sector Cover Letter_02_13_13.doc	Supplementary Document	Uploaded 2013-02-28	Available
C1_Private Sector Cover Letter_02_13_2013.doc	Supplementary Document	Uploaded 2013-02-28	Available
D2_Provider Survey Cover Sheet_02_13_13.doc	Supplementary Document	Uploaded 2013-02-28	Available
0920-12HN SS Part A_05_13_2013_clean version.docx	Supporting Statement A	Uploaded 2013-05-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
203904	Survey of non-Title X Clinic Administrators	Form	Modified	Administrator Survey Screenshots
203904	Survey of non-Title X Clinic Administrators	Form	Modified	Survey of Adminstrators of Publicly-Funded Health Centers that Provide Family Planning Services
203903	Survey of Title X Clinic Administrators	Form	Modified	Administrator Survey Screenshots
203903	Survey of Title X Clinic Administrators	Form	Modified	Survey of Administrators of Publicly-funded Health Centers that Provide Family Planning Services
203902	Survey of non-Title X Clinic Providers	Form	Modified	Provider Survery Screenshots
203902	Survey of non-Title X Clinic Providers	Form	Modified	Survey of Health Care Providers
203901	Survey of Title X Clinic Providers	Form	Modified	Provider Survey Screenshots
203901	Survey of Title X Clinic Providers	Form	Modified	Survey of Health Care Providers
203900	Survey of Office-based Physicians in Private Sector	Form	Modified	Provider Survey Screenshots
203900	Survey of Office-based Physicians in Private Sector	Form	Modified	Survey of Health Care Providers

ICR Details

OMB Control No: 0920-0969	ICR Reference No: 201303-0920-005
Status: Historical Active	Previous ICR Reference No: 201208-0920-008
Agency/Subagency: HHS/CDC	Agency Tracking No: 18979
Title: Monitoring Changes in Attitudes and Practices among Family Planning Providers and Clinics
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: 05/22/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/11/2013
Terms of Clearance: Approved consistent the reminder that phase 1 of the project was not within the approved scope of Epi-Aids and a more appropriate clearance mechanism needs to be found for any future collection similar to phase 1.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2014	12 Months From Approved
Responses	10,000	0	0
Time Burden (Hours)	4,166	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC plans to conduct surveys to monitor changes in provider and clinic attitudes and practices over time,partiularly in relationship to the dissemination of recent and future guidelines. Respondents will be health care providers in the private and public sectors, as well as administrators in Title X and Non-Title X clinics. Request is to support phase II data collection.

---

Authorizing Statute(s): US Code: 42 USC 301 Name of Law: PHSA
  

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 Private Sector	none, none	Survey of Health Care Providers ,   Provider Survey Screenshots
Survey of Title X Clinic Administrators	none, none	Survey of Administrators of Publicly-funded Health Centers that Provide Family Planning Services ,   Administrator Survey Screenshots
Survey of Title X Clinic Providers	none, none	Survey of Health Care Providers ,   Provider Survey Screenshots
Survey of non-Title X Clinic Administrators	none, none	Survey of Adminstrators of Publicly-Funded Health Centers that Provide Family Planning Services ,   Administrator Survey Screenshots
Survey of non-Title X Clinic Providers	none, none	Survey of Health Care Providers ,   Provider Survery Screenshots

---

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	10,000	0	0	10,000	0	0
Annual Time Burden (Hours)	4,166	0	0	4,166	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 a resubmission of a new ICR. OMB waived republication of the 30 day FRN. Request is for one year of approval to complete phase II.

---

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? 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: 03/11/2013

---