Evaluation of Core Violence and Injury Prevention Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Supplemental SOTS Survey Questions	Form	Removed	Available
Form 4 Core VIPP Non-Funded SHD: SOTS Financial Module	Form and Instruction	Removed	Available
Form 2 Core VIPP Non-funded State Health Department State of the States Survey	Form and Instruction	Removed	Available
Supporting Statement B.docx	Supporting Statement B	Uploaded 2014-03-25	Available
Attachment B - Published 60-day notice.pdf	Supplementary Document	Uploaded 2014-01-15	Available
Attachment A-Authorizing Legislation.docx	Supplementary Document	Uploaded 2014-01-15	Available
Attachment F-SOTS Supplement.docx	Supplementary Document	Uploaded 2013-02-13	Available
Supporting Statement A.docx	Supporting Statement A	Uploaded 2014-03-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210101	RNL Telephone Interview	Other-PDF	New
210100	MVP Telephone Interview	Other-PDF	New
210099	SQI Telephone Interview	Other-PDF	New
210098	RNL Needs Assessment Survey	Other-PDF	New
210097	RNL Network Satisfaction Survey	Other-PDF	New
210096	BIC Capacity Indicator Questionnaire	Other-PDF	New
205808	Supplemental SOTS Survey Questions	Form	Removed
200347	Core VIPP Non-Funded SHD: SOTS Financial Module	Form and Instruction	Removed
200346	SOTS Financial Module	Other-PDF	Modified
200345	BIC Telephone Interview	Other-WORD	Modified
200344	Core VIPP Non-funded State Health Department State of the States Survey	Form and Instruction	Removed
200343	State of the States Survey (SOTS)	Other-PDF	Modified

ICR Details

OMB Control No: 0920-0916	ICR Reference No: 201401-0920-005
Status: Historical Active	Previous ICR Reference No: 201302-0920-012
Agency/Subagency: HHS/CDC	Agency Tracking No: 21310
Title: Evaluation of Core Violence and Injury Prevention Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/28/2014
	Date Received in OIRA: 01/22/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	36 Months From Approved	03/31/2014
Responses	103	0	156
Time Burden (Hours)	163	0	284
Cost Burden (Dollars)	0	0	0

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Abstract: CDC is requesting a revision to the currently approved data collection which will allow more effective assessments for this program. The purpose of this ICR is to permit CDC to evaluate the Core VIPP program for the benefit of the Core VIPP grantees. This ICR has two overall goals: (1) to assess state injury and violence prevention plans for completeness, measurability, and effectiveness; and (2) evaluate the effectiveness of the Core VIPP cooperative agreement. Through the evaluation of the Core VIPP, CDC plans to improve state health department program and policy activities. The ultimate goal of the Core VIPP is to assist State Health Departments (SHDs) to build and/or maintain effective delivery systems for dissemination, implementation and evaluation of best practice programs and policies. This includes support for general capacity building of SHDs and their local partners, as well as strategy specific capacity building for the implementation of direct best practice interventions (older adult falls and child injury).

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: The Public Health and Welfare
  

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 48681	08/09/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 2674	01/15/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 9

table that charts list of burden

IC Title	Form No.	Form Name
State of the States Survey (SOTS)
BIC Telephone Interview
SOTS Financial Module
BIC Capacity Indicator Questionnaire
RNL Network Satisfaction Survey
RNL Needs Assessment Survey
SQI Telephone Interview
MVP Telephone Interview
RNL Telephone Interview
Core VIPP Non-funded State Health Department State of the States Survey	2	State of the States Survey in Word Format
Core VIPP Non-Funded SHD: SOTS Financial Module	4	Core VIPP Non-Funded SHD: SOTS Financial Module
Supplemental SOTS Survey Questions	none	Mock-up Screen Shots Supplement SOTS Survey

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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	103	156	0	-29	-24	0
Annual Time Burden (Hours)	163	284	0	-77	-44	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: Yes

Burden Reduction Due to: Changing Forms

Short Statement: This is a revision due to reduction in funded states.

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Annual Cost to Federal Government: $433,846

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: 01/22/2014

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