CDC Oral Health Management Information System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Enhanced level awardees - Annual progress report	Form	New	Repair queued
Enhanced level awardees - Initial MIS load	Form	New	Available
Basic level awardees - Annual progress report	Form	New	Available
Basic level awardees - Initial MIS population	Form	Modified	Available
SS-Part B_02 19 2014.doc	Supporting Statement B	Uploaded 2014-03-19	Available
Att 4. Performance Measures and Data Elements.docx	Supplementary Document	Uploaded 2014-03-19	Available
Att 3. Awardees.docx	Supplementary Document	Uploaded 2014-03-19	Available
Att 2B. Public Comments.doc	Supplementary Document	Uploaded 2014-03-19	Available
Att 2A. 60-day FRN.pdf	Supplementary Document	Uploaded 2014-03-19	Available
Att 1. PHSA.doc	Supplementary Document	Uploaded 2014-03-19	Available
SS-Part A_03 13 2014.doc	Supporting Statement A	Uploaded 2014-03-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210883	Enhanced level awardees - Annual progress report	Form	New
210882	Enhanced level awardees - Initial MIS load	Form	New
210881	Basic level awardees - Annual progress report	Form	New
178975	Basic level awardees - Initial MIS population	Form	Modified

ICR Details

OMB Control No: 0920-0739	ICR Reference No: 201403-0920-012
Status: Historical Active	Previous ICR Reference No: 201303-0920-008
Agency/Subagency: HHS/CDC	Agency Tracking No: 21598
Title: CDC Oral Health Management Information System
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/02/2014
	Date Received in OIRA: 03/24/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2017	36 Months From Approved	05/31/2014
Responses	28	0	20
Time Burden (Hours)	255	0	220
Cost Burden (Dollars)	0	0	0

---

Abstract: Under a new FOA, CDC provides basic or enhanced level funding to 21 oral health programs in states and territories. An electronic MIC-based reporting system is being revised to align the monitoring plan and performance measures for oral health programs withthe plan and measures used for other chronic disease programs.

---

Authorizing Statute(s): US Code: 42 USC 247(b)(k)(2) Name of Law: null
   US Code: 42 USC 301 Name of Law: PHSA
   US Code: 42 USC 241(a) Name of Law: Research and Investigation in General
  

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 75352	12/11/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 15347	03/19/2014
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Basic level awardees - Initial MIS population	none	Chronic Disease MIS
Basic level awardees - Annual progress report	none	Chronic Disease MIS
Enhanced level awardees - Initial MIS load	none	Chronic Disease MIS
Enhanced level awardees - Annual progress report	none	Chronic Disease MIS

---

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	28	20	0	8	0	0
Annual Time Burden (Hours)	255	220	0	35	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The number of awardees has increased to 21; the MIS platform and data elements have changed to improve alignment with other programs. A modified method of estimating burden has been employed resulting in a small increase in burden.

---

Annual Cost to Federal Government: $13,200

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: 03/24/2014

---