Evaluation of Hospital Preparedness in a Mass Casualty Event

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Survey	Form	New	Available
Supporting Statement A_OMBcomments_011315.docx	Supporting Statement A	Uploaded 2015-01-15	Available
Attachment H - Consent Form.doc	Supplementary Document	Uploaded 2014-09-25	Available
Attachment G - Public Comment.docx	Supplementary Document	Uploaded 2014-09-25	Available
Attachment C - Invitation letters.docx	Supplementary Document	Uploaded 2014-09-25	Available
Attachment F - NCIPC Determination - Hospital Preparedness.pdf	Supplementary Document	Uploaded 2014-09-24	Available
Attachment B Published 60-day notice.pdf	Supplementary Document	Uploaded 2014-09-24	Available
Attachment A - Authorizing Legislation.doc	Supplementary Document	Uploaded 2014-09-24	Available
Supporting Statement B.docx	Supporting Statement B	Uploaded 2014-09-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213247	Follow-up Phone Call to CEOs	Other-Phone Call	New
213237	Survey	Form	New

ICR Details

OMB Control No: 0920-1042	ICR Reference No: 201409-0920-012
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 14QJ
Title: Evaluation of Hospital Preparedness in a Mass Casualty Event
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: 01/16/2015
	Date Received in OIRA: 10/09/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2016	12 Months From Approved
Responses	720	0	0
Time Burden (Hours)	740	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The overarching goal of this data collection is to assess national capacity of trauma and non-trauma hospitals to respond to mass casualty incidents involving bombings or non-bombing explosions. Understanding the current capacities will allow the CDC's Division of Unintentional Injury Prevention (DUIP) to develop strategies that address major hospital preparedness gaps.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

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:
	79 FR 24440	04/30/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 59270	10/01/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Follow-up Phone Call to CEOs
Survey	none	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	720	0	0	720	0	0
Annual Time Burden (Hours)	740	0	0	740	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 data collection request.

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Annual Cost to Federal Government: $162,562

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 10/09/2014

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