Monitoring and Reporting System for DELTA FOCUS Awardees

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
12QR_Sup Sta B.docx	Supporting Statement B	Uploaded 2013-03-18	Available
Att 2b - 60d Pub Cmmts.docx	Supplementary Document	Uploaded 2013-03-18	Repair queued
Att 2a - Pubd 60d FRN.pdf	Supplementary Document	Uploaded 2013-03-18	Available
Att 1b - Autho Leg.docx	Supplementary Document	Uploaded 2013-03-18	Available
Att 1a - Autho Leg.docx	Supplementary Document	Uploaded 2013-03-18	Available
Att 1 - Autho Leg.pdf	Supplementary Document	Uploaded 2013-03-18	Available
12QR_Sup Sta A.docx	Supporting Statement A	Uploaded 2013-03-18	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206294	DELTA FOCUS PMIS: Semi-annual reporting	Other-WORD	New
206293	DELTA FOCUS PMIS: Initial population	Other-WORD	New

ICR Details

OMB Control No: 0920-0968	ICR Reference No: 201303-0920-016
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 19163
Title: Monitoring and Reporting System for DELTA FOCUS Awardees
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 without change	Conclusion Date: 05/22/2013
	Date Received in OIRA: 03/29/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2016	36 Months From Approved
Responses	30	0	0
Time Burden (Hours)	210	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the DELTA FOCUS program is to promote the prevention of Intimate Partner Violence (IPV) through the implementation and evaluation of strategies that create a foundation for the development of practice-based evidence. By emphasizing primary prevention, this program will support comprehensive and coordinated approaches to IPV prevention. The strategies will address the structural determinants of health at the outer layers (societal and community) of the social-ecological model (SEM) that coordinate and align with existing prevention strategies at the inner layers of the SEM. This program addresses the "Healthy People 2020" focus area(s) of Injury and Violence Prevention and Social Determinants of Health

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Authorizing Statute(s): US Code: 1 USC 101 Name of Law: Child Abuse Prevention and Treatment Act
   US Code: 42 USC 201 Name of Law: Family Violence Prevention and Services Act
   US Code: 42 USC 314 Name of Law: Domestic Violence Prevntion Enhancement and Leadership Through Alliances (DELTA)
   US Code: 42 USC 317(k)(2) 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
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 49798	08/17/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 17409	03/21/2013
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
DELTA FOCUS PMIS: Initial population
DELTA FOCUS PMIS: Semi-annual reporting

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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	30	0	0	30	0	0
Annual Time Burden (Hours)	210	0	0	210	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 NEW collection request for a new OMB Control Number.

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Annual Cost to Federal Government: $166,800

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

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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: 03/29/2013

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