Study to Explore Educational Children's Book in Pediatric Offices

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Consent	Form and Instruction	New	Available
Focus Group Screener	Form	New	Available
Follow-up Survey	Form	New	Available
Parent Survey	Form	New	Available
Supplemental 3_Amazing_Me_Final_Version_508_Part2.pdf	Supplementary Document	Uploaded 2013-08-02	Available
Supporting Statement B_Westat response07122013.docx	Supporting Statement B	Uploaded 2013-07-22	Available
Supplemental 3_Amazing_Me_Final_Version_508_Part1.pdf	Supplementary Document	Uploaded 2013-07-29	Available
Supplemental 2 Amazing Me IRB Amendment Form Approval.pdf	Supplementary Document	Uploaded 2013-07-22	Available
Supplemental 1 Amazing Me IRB Approval Letter.pdf	Supplementary Document	Uploaded 2013-07-22	Available
60dy_FRN.pdf	Supplementary Document	Uploaded 2013-07-22	Available
Attachment 1 Applicable Laws or Regulations.docx	Supplementary Document	Uploaded 2013-07-22	Available
Attachment 4 Amazing Me Parent Follow-Up Contact Survey FINAL Mar 15 2013.docx	Supplementary Document	Uploaded 2013-07-22	Available
Attachment 3 Amazing Me Parent Web Survey FINAL Mar 15 2013.docx	Supplementary Document	Uploaded 2013-07-22	Available
SupportingStmnt A_Westat response07122013.docx	Supporting Statement A	Uploaded 2013-07-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
208017	Focus Group Moderator's Guide	Instruction	New
208016	Focus Group Consent	Form and Instruction	New	Consent
208015	Focus Group Screener	Form	New	Focus Group Screener
208014	Follow-up Web Survey	Form	New	Follow-up Survey
208013	Web Survey	Form	New	Parent Survey

ICR Details

OMB Control No: 0920-0991	ICR Reference No: 201308-0920-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 20096
Title: Study to Explore Educational Children's Book in Pediatric Offices
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: 09/26/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/01/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2014	12 Months From Approved
Responses	1,968	0	0
Time Burden (Hours)	229	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC's NCBDDD will conduct this study to assess the influence of the children's book, Amazing Me in pediatric office settings where the book will be distributed to parents of 3-year-old children, soon to be 3-year olds, and recently turned 4-year olds. The findings will help CDC determine if distribution of the book through RoR/pediatric office settings is an appropriate approach for delivering information about child development to parents and if children's literature is an appropriate approach for reaching parents and caregivers with health related messages.

---

Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
  

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:
	78 FR 20111	04/03/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 44568	07/24/2013
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
Focus Group Consent	none	Consent
Focus Group Moderator's Guide
Focus Group Screener	none	Focus Group Screener
Follow-up Web Survey	none	Follow-up Survey
Web Survey	none	Parent Survey

---

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	1,968	0	0	1,968	0	0
Annual Time Burden (Hours)	229	0	0	229	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 ICR.

---

Annual Cost to Federal Government: $120,001

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: 08/01/2013

---