Early Hearing Detection and Intervention Hearing Screening and Follow-up survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Early Hearing Detecton and Intervention Hearing Screening and Follow-up survey	Form and Instruction	Modified	Available
Supp_Statement_B_ EHDI_OMB_2013_Renewal_Draft - Clean.doc	Supporting Statement B	Uploaded 2013-07-02	Available
Attach_2_60day_FRN.pdf	Supplementary Document	Uploaded 2013-07-02	Available
Attach_14_2013_NonResEmail.docx	Supplementary Document	Uploaded 2013-07-02	Available
Attach_13_2013_reminder.docx	Supplementary Document	Uploaded 2013-07-02	Available
Attach_12_2013_invite.docx	Supplementary Document	Uploaded 2013-07-02	Available
Attach_11_2013_UnclearResEmail.docx	Supplementary Document	Uploaded 2013-07-02	Repair queued
Attach_10_2013_DataRpts.docx	Supplementary Document	Uploaded 2013-07-02	Available
Attach_9_2013_ResDet.docx	Supplementary Document	Uploaded 2013-07-02	Available
Attach_8_2013_ENT.docx	Supplementary Document	Uploaded 2013-07-02	Available
Attach_7_2013_CO_LOS.docx	Supplementary Document	Uploaded 2013-07-02	Available
Attach_6_2013_LOS.docx	Supplementary Document	Uploaded 2013-07-02	Available
Attach_5_2013.docx	Supplementary Document	Uploaded 2013-07-02	Available
Attach_3_2013_Goals.docx	Supplementary Document	Uploaded 2013-07-02	Available
Attach_1_2013_Laws.docx	Supplementary Document	Uploaded 2013-07-02	Available
Supp_Statement_A_EHDI_OMB_2013_(06212013).docm	Supporting Statement A	Uploaded 2013-07-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43622	Early Hearing Detecton and Intervention Hearing Screening and Follow-up survey	Form and Instruction	Modified
207643	Survey Directions	Instruction	New
192922	CDC EHDI Hearing Screening and Followup Survey (HSFS)	Instruction	Removed

ICR Details

OMB Control No: 0920-0733	ICR Reference No: 201307-0920-002
Status: Historical Active	Previous ICR Reference No: 201005-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No: 19917
Title: Early Hearing Detection and Intervention Hearing Screening and Follow-up survey
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/14/2013
	Date Received in OIRA: 07/03/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2016	36 Months From Approved
Responses	114	0	0
Time Burden (Hours)	230	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This data collection is intended to target only state and territorial EHDI program directors. NCBDDD will utilize a revised survey to collect standardized annual state data related to the number of children screened for hearing loss, referred for and receiving follow-up testing (e.g., diagnostic audiologic evaluation).

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Authorizing Statute(s): PL: Pub.L. 42 - 241 301 Name of Law: Public Health Service Act
   PL: Pub.L. 42 - 247 317 Name of Law: Children's Health Act
   PL: Pub.L. 42 - 247 399 Name of Law: Children's Health Act of 2000
  

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:
	78 FR 18986	03/28/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 39295	07/01/2013
Did the Agency receive public comments on this ICR? No

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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
Early Hearing Detecton and Intervention Hearing Screening and Follow-up survey	None, None	Screenshots for CDC EHDI Hearing Screening and Follow-up Survey (HSFS) ,   CDC EHDI Hearing Screening and Follow-up Survey (HSFS)
Survey Directions
CDC EHDI Hearing Screening and Followup Survey (HSFS)	2	CDC EHDI Hearing Screening and Follow-up Survey (HSFS)

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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	114	0	0	114	0	0
Annual Time Burden (Hours)	230	0	0	230	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 reinstatement with change ICR. Minor change to burden due to changes which include changing the order of some questions, splitting the previously combined question about the number of infants that were non-residents or moved out jurisdiction into two separate questions and adding new questions. These include questions asked about how many infants were in a neonatal intensive care unit (NICU) for more than 5 days, transferred without any documentation of a hearing screening, unable to be screened or receive diagnostic testing due to a medical reason, number of cases where a primary care physician did not refer an infant for diagnostic testing, and cases of permanent hearing loss among non-resident infants. Complete discussion of changes are found in SSA.15, page 15-17.

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Annual Cost to Federal Government: $5,475

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: 07/03/2013

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