Adoption, Health Impact and Cost of Smoke-Free Multi-Unit Housing Policies

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Focus Group Guide	Form	New	Available
Resident Pre-Focus Group Survey	Form	New	Available
Focus Group Screener	Form	Modified	Available
Saliva Collection	Form and Instruction	Modified	Available
Resident Survey Post-int - children's module section G Spanish	Form	Modified	Available
Resident Survey Post-int- children's module section G	Form	Modified	Available
Resident Survey - Post-intervention	Form	Modified	Available
Resident Surevy Post-intervention Spanish	Form	Modified	Available
MUH Resident Baseline - Children's Module section G Spanish	Form	Modified	Available
MUH Resident Baseline - Children's Module section G	Form	Modified	Available
MUH Resident Baseline - Core - sections A-F Spanish	Form	Modified	Available
MUH Resident Baseline - Core - sections A-F	Form	Modified	Available
MUH Resident Survey - LA (Spanish)	Form	Modified	Available
MUH Resident Survey - LA (English)	Form	Modified	Available
MUH Operator Post Intervention Survey - LA, ME, MN, FL	Form	Modified	Available
7A - MUH operator post-intervention survey - LA county	Form	Modified	Available
Recruitment phone script MN, ME, FL	Form and Instruction	Modified	Available
MUH Operator Baseline Survey - MN, ME, FL	Form	Modified	Available
MUH Operator Baseline Survey	Form	Modified	Available
Recruitment Script LA	Form	Modified	Available
clean 12 17 13 MUH SS Part B 09 19 13.doc	Supporting Statement B	Uploaded 2013-12-19	Available
Att 14_CDC IRB Approval renewal 5.13.13.docx	Supplementary Document	Uploaded 2013-09-24	Available
revised 12.17.13 Att 3D Logic Model_8 27 2012 9.3.13_updated.doc	Supplementary Document	Uploaded 2013-12-19	Available
clean 12.17.13 Att 3C_Data Collection Flow Chart 9.3.13.doc	Supplementary Document	Uploaded 2013-12-19	Available
clean 12.17.13 Att 3B_Sources of Survey Questions 9.3.13.doc	Supplementary Document	Uploaded 2013-12-19	Available
clean 12.17.13 Att 3A_Effect Sizes 9.3.13.doc	Supplementary Document	Uploaded 2013-12-19	Available
Att 2B_Summary of Public Comments.doc	Supplementary Document	Uploaded 2013-08-22	Available
Att 2A_Federal Register Notice.pdf	Supplementary Document	Uploaded 2013-08-22	Available
Att 1D_PPHF.PDF	Supplementary Document	Uploaded 2013-08-22	Available
Att 1C_Affordable Care Act.pdf	Supplementary Document	Uploaded 2013-08-22	Available
Att 1B_PHSA.DOCX	Supplementary Document	Uploaded 2013-08-22	Available
Att 1A_ARRA of 2009.pdf	Supplementary Document	Uploaded 2013-08-22	Available
Att 13A-1_Focus Group Consent_9.3.13.docx	Supplementary Document	Uploaded 2013-09-24	Available
Att 13A-1_Focus Group Consent_9.3.13.docx	Supplementary Document	Uploaded 2013-09-24	Available
Att 13A-1_Focus Group Consent_9.3.13.docx	Supplementary Document	Uploaded 2013-09-23	Available
Att 12A-1_Focus Group Recruitment Flyer.docx	Supplementary Document	Uploaded 2013-09-23	Available
Att 12A-2(e) Other Focus Group Recruitment Materials_9.3.13.docx	Supplementary Document	Uploaded 2013-09-23	Available
clean 12.17.13 Att 10-A1(e)_MUH Child Assent for Saliva 5_16_13.docx	Supplementary Document	Uploaded 2013-12-19	Available
clean 12 13 13 Att 10-A1(s)_MUH Child Assent for Saliva 5_16_13.docx	Supplementary Document	Uploaded 2013-12-19	Available
Att 11A_Protocol for Air Monitoring.doc	Supplementary Document	Uploaded 2013-09-23	Available
clean 12 17 13 Att 8A-3(s) LA Resident Consent for Child Questions_9 3 1....docx	Supplementary Document	Uploaded 2013-12-19	Available
Att 8A-3(e) LA Resident Consent for Child Questions_9.3.13.docx	Supplementary Document	Uploaded 2013-09-23	Available
Att 8A-2(s) MUHAdult Resident HIPPA form 9.3.13.docx	Supplementary Document	Uploaded 2013-09-23	Available
Att 8A-2(e) MUHAdult Resident HIPPA form_9.3.13.docx	Supplementary Document	Uploaded 2013-09-23	Available
clean 12 17. 13 Att 8A-1(s) MUH Resident Adult Participant Consent_9 3 1....docx	Supplementary Document	Uploaded 2013-12-19	Available
clean 12.17.13 Att 8A-1(e) MUH Resident Adult Participant Consent_9.3.......docx	Supplementary Document	Uploaded 2013-12-19	Available
clean 12 13 13 Att 8A-4(s)_Resident Recruitment Materials_9 3 13.docx	Supplementary Document	Uploaded 2013-12-19	Available
clean 12.17.13 Att 8A-4(e)_Resident Recruitment Materials_9.3.13.docx	Supplementary Document	Uploaded 2013-12-19	Available
Att 8A-3(s) LA Resident Consent for Child Questions_9.3.13.docx	Supplementary Document	Uploaded 2013-09-23	Available
clean 12.17.13 Att 8A-3(e) LA Resident Consent for Child Questions_9.3......docx	Supplementary Document	Uploaded 2013-12-19	Available
Att 8A-2(s) MUHAdult Resident HIPPA form 9.3.13.docx	Supplementary Document	Uploaded 2013-09-23	Available
Att 8A-2(e) MUHAdult Resident HIPPA form_9.3.13.docx	Supplementary Document	Uploaded 2013-09-23	Available
clean 12.17.13 Att 8A-1(e) MUH Resident Adult Participant Consent_9.3.......docx	Supplementary Document	Uploaded 2013-12-19	Available
Att 8A-1(s) MUH Resident Adult Participant Consent 9.3.13.docx	Supplementary Document	Uploaded 2013-09-23	Available
clean 12.17.13 Att 6A-2(e) MUH Operator Survey Consent MN ME FL_9.3.13 c....docx	Supplementary Document	Uploaded 2013-12-19	Available
Att 6A-1(e) MUH Operator Consent LA_9.3.13.docx	Supplementary Document	Uploaded 2013-09-23	Available
clean 12.17.13 Att 4A-1(e) Letter to Property Management_9.3.13.docx	Supplementary Document	Uploaded 2013-12-19	Available
clean 12.17.13 MUH SS Part A 09 19 13.docx	Supporting Statement A	Uploaded 2013-12-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
208870	Resident Focus Group Guide - Outcome Oriented	Instruction	New
208869	Resident Focus Group Guide - Process Oriented	Form	New	Focus Group Guide
208868	Resident Pre-Focus Group Survey	Form	New	Resident Pre-Focus Group Survey
204450	Resident Focus Group Screening	Form	Modified	Focus Group Screener
204449	MUH Saliva Collection - children	Instruction	Modified
204448	MUH Resident Air Quality Monitoring	Instruction	Modified
204447	MUH Resident Saliva Collection	Form and Instruction	Modified	Saliva Collection
204446	MUH Resident Post-intervention Children's Module - LA	Form	Modified	Resident Survey Post-int - children's module section G Spanish
204446	MUH Resident Post-intervention Children's Module - LA	Form	Modified	Resident Survey Post-int- children's module section G
204445	MUH Resident Post-intervention Survey - Core LA	Form	Modified	Resident Survey - Post-intervention
204445	MUH Resident Post-intervention Survey - Core LA	Form	Modified	Resident Surevy Post-intervention Spanish
204444	MUH Resident Baseline Survey - Children's Module LA	Form	Modified	MUH Resident Baseline - Children's Module section G Spanish
204444	MUH Resident Baseline Survey - Children's Module LA	Form	Modified	MUH Resident Baseline - Children's Module section G
204443	MUH Resident Baseline Survey - Core LA	Form	Modified	MUH Resident Baseline - Core - sections A-F Spanish
204443	MUH Resident Baseline Survey - Core LA	Form	Modified	MUH Resident Baseline - Core - sections A-F
204442	MUH Resident Baseline Survey - screening LA	Form	Modified	MUH Resident Survey - LA (Spanish)
204442	MUH Resident Baseline Survey - screening LA	Form	Modified	MUH Resident Survey - LA (English)
204441	MUH operators post-intervention survey - MN, ME, FL	Form	Modified	MUH Operator Post Intervention Survey - LA, ME, MN, FL
204440	MUH Operator Post-intervention Survey - LA county	Form	Modified	7A - MUH operator post-intervention survey - LA county
204439	Phone script for recruitment of MUH operators - MN, ME, FL	Form and Instruction	Modified	Recruitment phone script MN, ME, FL
204438	MUH Operator Baseline Survey - MN, ME, FL	Form	Modified	MUH Operator Baseline Survey - MN, ME, FL
204437	MUH Operator Baseline Survey (LA County)	Form	Modified	MUH Operator Baseline Survey
204436	Phone script for Recruitment of MUH operators in LA	Form	Modified	Recruitment Script LA

ICR Details

OMB Control No: 0920-1004	ICR Reference No: 201309-0920-011
Status: Historical Active	Previous ICR Reference No: 201210-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No: 20360
Title: Adoption, Health Impact and Cost of Smoke-Free Multi-Unit Housing Policies
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: 12/27/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/30/2013
Terms of Clearance: Approved consistent with CDC's primary goal for the quasi-experimental component - to detect changes in SHS exposure and occupants’ knowledge and behavior. The survey is not designed (or powered) to detect changes in respiratory health outcomes associated with SHS policies or changes in exposure. The health information collected will only be used as covariates in analyses alongside other demographic characteristics such as age, sex, and race.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2016	24 Months From Approved
Responses	4,664	0	0
Time Burden (Hours)	1,922	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC plans to conduct a series of projects designed to explore the potential impacts of smoke-free policies in multi-unit residential housing facilities One project is a quasi-experimental pretest, posttest design study with an intervention group and a comparison group to explore changes in behavior and exposure among residents in Los Angeles. This quasi-experimental study is not des igned to detect changes in residents' health. Other study components include surveys of multi-unit housing (MUH) operators and residents, objective measures of air quality and tobacco exposure, and focus groups with residents in three states with different policies.

---

Authorizing Statute(s): PL: Pub.L. 111 - 5 8 Name of Law: ARRA
   US Code: 42 USC 301 Name of Law: PHSA
   PL: Pub.L. 111 - 148 4002 Name of Law: ACA
  

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 17065	03/23/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 61407	10/09/2012
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 18

table that charts list of burden

IC Title	Form No.	Form Name
MUH Operator Baseline Survey (LA County)	none	MUH Operator Baseline Survey
MUH Operator Baseline Survey - MN, ME, FL	none	MUH Operator Baseline Survey - MN, ME, FL
MUH Operator Post-intervention Survey - LA county	none	7A - MUH operator post-intervention survey - LA county
MUH Resident Air Quality Monitoring
MUH Resident Baseline Survey - Children's Module LA	none, none	MUH Resident Baseline - Children's Module section G ,   MUH Resident Baseline - Children's Module section G Spanish
MUH Resident Baseline Survey - Core LA	none, none	MUH Resident Baseline - Core - sections A-F ,   MUH Resident Baseline - Core - sections A-F Spanish
MUH Resident Baseline Survey - screening LA	none, none	MUH Resident Survey - LA (English) ,   MUH Resident Survey - LA (Spanish)
MUH Resident Post-intervention Children's Module - LA	none, none	Resident Survey Post-int- children's module section G ,   Resident Survey Post-int - children's module section G Spanish
MUH Resident Post-intervention Survey - Core LA	none, none	Resident Surevy Post-intervention Spanish ,   Resident Survey - Post-intervention
MUH Resident Saliva Collection	none	Saliva Collection
MUH Saliva Collection - children
MUH operators post-intervention survey - MN, ME, FL	none	MUH Operator Post Intervention Survey - LA, ME, MN, FL
Phone script for Recruitment of MUH operators in LA	none	Recruitment Script LA
Phone script for recruitment of MUH operators - MN, ME, FL	none	Recruitment phone script MN, ME, FL
Resident Focus Group Guide - Outcome Oriented
Resident Focus Group Guide - Process Oriented	none	Focus Group Guide
Resident Focus Group Screening	none	Focus Group Screener
Resident Pre-Focus Group Survey	none	Resident Pre-Focus Group 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	4,664	0	0	4,664	0	0
Annual Time Burden (Hours)	1,922	0	0	1,922	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 resubmission of a previously submitted new ICR. OMB has waived republication of the FRNs.

---

Annual Cost to Federal Government: $2,028,456

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]? Yes

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: 09/30/2013

---