Public Health Systems, Mental Health and Community Recovery Project

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Household Survey for General Public_Study Screener	Form and Instruction	New	Repair queued
Household Survey for General Public and Consent	Form and Instruction	New	Available
Key Informant Interview Guide_Consent Form	Form and Instruction	New	Available
Key Informant Interview Guide_Consent Form	Form and Instruction	New	Available
Suppporting Statement Part B_8152013.docx	Supporting Statement B	Uploaded 2013-08-27	Available
Attachment L_ Household Survey for General Public_ Postcard to Indicate Interest.docx	Supplementary Document	Uploaded 2013-08-27	Available
Attachment K_ Household Survey for General Public_ Letter for Addresses without Matched Phone Numbers.docx	Supplementary Document	Uploaded 2013-08-27	Available
Attachment I- ICF IRB Approval Form.pdf	Supplementary Document	Uploaded 2013-08-27	Available
Attachment A_Section 241 of the Public Health Service Act (42 U.S.C. 241....pdf	Supplementary Document	Uploaded 2013-08-27	Available
Attachment J_ Household Survey for General Public_ Letter for Addresses with Matched Phone Numbers.docx	Supplementary Document	Uploaded 2013-08-27	Repair queued
Supporting Statement Part A _8152013.docx	Supporting Statement A	Uploaded 2013-08-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
208429	Household Survey for General Public_Study Screener	Form and Instruction	New	Household Survey for General Public_Study Screener
208428	Household Survey (Telephone) for General Public and Consent	Form and Instruction	New	Household Survey for General Public and Consent
208427	Key Informant Interview Guide_Community Organization Respondents	Form and Instruction	New	Key Informant Interview Guide_Consent Form
208427	Key Informant Interview Guide_Community Organization Respondents	Other-Interview Guide	New
208426	Key Informant Interview Guide_PH/MH Agency Staff	Form and Instruction	New	Key Informant Interview Guide_Consent Form
208426	Key Informant Interview Guide_PH/MH Agency Staff	Other-Interview Guide	New

ICR Details

OMB Control No: 0920-0993	ICR Reference No: 201308-0920-012
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 20396
Title: Public Health Systems, Mental Health and Community Recovery Project
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: 09/30/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/29/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2015	24 Months From Approved
Responses	8,790	0	0
Time Burden (Hours)	1,706	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This project stems from, and aligns with, publication of the Office of Public Health Preparedness and Response's (OPHPR) "National Strategic Plan for Public Health Preparedness and Response" which provides overall direction for Centers for Disease Control and Prevention's (CDC) preparedness and response portfolio, including programmatic direction across OPHPR's four divisions. The focus of this project is to generate findings useful for future preparedness planning and response in order to develop strategies and interventions aimed at mitigating the impact of adverse events. In April 2011, one of the largest tornado outbreaks ever recorded, a "Super Outbreak," occurred in the southeastern United States, resulting in more than 300 deaths and an estimated $11 million in damages. CDC, in collaboration with ICF International, will conduct a mixed method evaluation utilizing key informant interviews of public health and mental health agency staff and other community representatives at the local, county and State levels and household survey data in each of the communities to assess community recovery and resilience. Specifically, the study design includes two main components (qualitative and quantitative) designed to comprehensively examine the PH/MH system response to and community recovery and resilience from disasters.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health and Welfare--Research and Investigations Generally
  

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 25088	04/29/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 52771	08/26/2013
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Household Survey (Telephone) for General Public and Consent	None	Household Survey for General Public and Consent
Household Survey for General Public_Study Screener	None	Household Survey for General Public_Study Screener
Key Informant Interview Guide_Community Organization Respondents	None	Key Informant Interview Guide_Consent Form
Key Informant Interview Guide_PH/MH Agency Staff	None	Key Informant Interview Guide_Consent Form

---

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	8,790	0	0	8,790	0	0
Annual Time Burden (Hours)	1,706	0	0	1,706	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 Information Collection Request.

---

Annual Cost to Federal Government: $457,384

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: 08/29/2013

---