Determining Causes of Sudden, Unexpected Infant Death: A National Survey of U.S. Medical Examiners and Coroners

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
SS Part B.docx	Supporting Statement B	Uploaded 2013-08-27	Available
Att 6_Illustrative Table Shells.DOCX	Supplementary Document	Uploaded 2013-08-27	Available
Att 5_Battelle IRB Approval Letter.pdf	Supplementary Document	Uploaded 2013-08-27	Available
Att 2b_Summary of Public Comments.doc	Supplementary Document	Uploaded 2013-08-27	Available
Att 2a_60-day FRN.PDF	Supplementary Document	Uploaded 2013-08-27	Available
Att 1_Authorizing Legislation.docx	Supplementary Document	Uploaded 2013-08-27	Available
Att 4d_Reminder Call.docx	Supplementary Document	Uploaded 2013-08-27	Available
Att 4c_Reminder_Thank You Postcard.docx	Supplementary Document	Uploaded 2013-08-27	Available
Att 4b_Survey Cover Letter.docx	Supplementary Document	Uploaded 2013-08-27	Repair queued
SS_Part_A_11 01 2013.docx	Supporting Statement A	Uploaded 2013-11-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
208415	Screener	Other-WORD	New
208414	National Survey of Coroners	Other-WORD	New
208413	National Survey of Medical Examiners	Other-WORD	New

ICR Details

OMB Control No: 0920-0999	ICR Reference No: 201308-0920-011
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 20419
Title: Determining Causes of Sudden, Unexpected Infant Death: A National Survey of U.S. Medical Examiners and Coroners
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: 11/08/2013
	Date Received in OIRA: 08/28/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2014	12 Months From Approved
Responses	1,440	0	0
Time Burden (Hours)	387	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC plans to conduct a mail survey of medical examiners and coroners to describe knowledge, opinions, diagnostic and reporting practices relating to sudden unexpected infant deaths.

---

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:
	77 FR 69485	11/19/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 52532	08/23/2013
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
National Survey of Medical Examiners
National Survey of Coroners
Screener

---

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	1,440	0	0	1,440	0	0
Annual Time Burden (Hours)	387	0	0	387	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 Request for a NEW OMB Control Number for a one-time study.

---

Annual Cost to Federal Government: $312,500

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? Yes

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: 08/28/2013

---