Information Collection on Cause-Specific Absenteeism in Schools (Pittsburgh Location)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
SMART2 Cohort Project Consent Form 23MAR2015	Form and Instruction	New	Available
Cohort Weekly Illness Report	Form	New	Available
Cohort Intake Form	Form	New	Available
Oral Script to obtain assent from Children 13 plus (in the Nurse's office)	Form and Instruction	New	Available
Oral Script to obtain assent from Children 13 plus (after return to school from absence)	Form and Instruction	New	Available
Oral Script to obtain assent from Children 7-12 (in the Nurse's office)	Form and Instruction	New	Available
Oral Script to obtain assent from Children 7-12 (after return to school from absence)	Form and Instruction	New	Available
Oral Script to obtain assent from Children 5-6 (in the Nurse's office)	Form and Instruction	New	Available
Oral Script to obtain Assent from Children 5-6 (after return to school from absence)	Form and Instruction	New	Available
Absentee Reporting Form - Survey of Parent or Child 24MAR2015	Form	New	Available
Attachment D5 Amendment Approval Notice_FINAL.pdf	Supplementary Document	Uploaded 2015-03-23	Available
FW alleged flu pandemics by cdc - they inflate the nujmbers.txt	Supplementary Document	Uploaded 2015-01-05	Available
Attachment E Parent opt out letter.docx	Supplementary Document	Uploaded 2014-12-31	Available
Attachment D4 CDC IRB deferral letter.pdf	Supplementary Document	Uploaded 2014-12-31	Available
Attachment D3 University of Pittsburg – IRB approval.pdf	Supplementary Document	Uploaded 2014-12-31	Available
Attachment D2 Johns Hopkins University – IRB approval.pdf	Supplementary Document	Uploaded 2014-12-31	Available
Attachment D1 Approved Protocol 31DEC2014.docx	Supplementary Document	Uploaded 2014-12-31	Available
Attachment C School district support letters.pdf	Supplementary Document	Uploaded 2014-12-31	Available
Attachment B 60-Day FRN Absentee Pittsburgh.docx	Supplementary Document	Uploaded 2014-12-31	Available
Attachment A3 Section 301 of the Public Health Service Act (42 USC 241).pdf	Supplementary Document	Uploaded 2014-12-31	Available
Attachment A2 Code of Federal Regulations part 70.pdf	Supplementary Document	Uploaded 2014-12-31	Available
Attachment A1 Section 361 of the Public Health Service Act (42 USC 264)..pdf	Supplementary Document	Uploaded 2014-12-31	Available
SSB Pitt School Absentee 31DEC2014.docx	Supporting Statement B	Uploaded 2014-12-31	Available
Supporting Statement A Pitt School Absentee_3 20 15.docx	Supporting Statement A	Uploaded 2015-03-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
214478	Biospecimen Collection from Sentinel Cohort (Students and Household Members)	Form and Instruction	New	SMART2 Cohort Project Consent Form 23MAR2015
214477	Sentinel Family Cohort Weekly Illness Report	Form	New	Cohort Weekly Illness Report
214476	Sentinel Family Cohort Intake Form	Form	New	Cohort Intake Form
214475	Bioispecimen Collection from Students (Absentee Surveillance)	Form and Instruction	New	Oral Script to obtain assent from Children 13 plus (in the Nurse's office)
214475	Bioispecimen Collection from Students (Absentee Surveillance)	Form and Instruction	New	Oral Script to obtain assent from Children 13 plus (after return to school from absence)
214475	Bioispecimen Collection from Students (Absentee Surveillance)	Form and Instruction	New	Oral Script to obtain assent from Children 7-12 (in the Nurse's office)
214475	Bioispecimen Collection from Students (Absentee Surveillance)	Form and Instruction	New	Oral Script to obtain assent from Children 7-12 (after return to school from absence)
214475	Bioispecimen Collection from Students (Absentee Surveillance)	Form and Instruction	New	Oral Script to obtain assent from Children 5-6 (in the Nurse's office)
214475	Bioispecimen Collection from Students (Absentee Surveillance)	Form and Instruction	New	Oral Script to obtain Assent from Children 5-6 (after return to school from absence)
214474	School Absentee Reporting Form	Form	New	Absentee Reporting Form - Survey of Parent or Child 24MAR2015

ICR Details

OMB Control No: 0920-1056	ICR Reference No: 201412-0920-016
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 14AYK
Title: Information Collection on Cause-Specific Absenteeism in Schools (Pittsburgh Location)
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: 03/25/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/08/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	36 Months From Approved
Responses	26,120	0	0
Time Burden (Hours)	2,062	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Disease Control and Prevention (CDC), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Global Migration and Quarantine (DGMQ), requests approval of a new information collection on Cause-Specific Absenteeism in Schools. This information collection aims to improve our understanding of the role of cause-specific absenteeism in schools in predicting community-wide influenza transmission. We will obtain information on how influenza spreads among children in school and between children and the community. This will lead to greater accuracy in determining where, when, and for how long to implement school-related influenza mitigation measures. Insights gained from this information collection will be used to strengthen the evidence-base of CDC's Pre-Pandemic Guidance prior to the next pandemic.

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Authorizing Statute(s): US Code: 42 USC 242 Name of Law: Public Health Service Act
   US Code: 42 USC 264 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 55495	09/16/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 228	01/05/2015
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Bioispecimen Collection from Students (Absentee Surveillance)	None, None, None, None, None, None	Oral Script to obtain Assent from Children 5-6 (after return to school from absence) ,   Oral Script to obtain assent from Children 5-6 (in the Nurse's office) ,   Oral Script to obtain assent from Children 7-12 (after return to school from absence) ,   Oral Script to obtain assent from Children 7-12 (in the Nurse's office) ,   Oral Script to obtain assent from Children 13 plus (after return to school from absence) ,   Oral Script to obtain assent from Children 13 plus (in the Nurse's office)
Biospecimen Collection from Sentinel Cohort (Students and Household Members)	None	SMART2 Cohort Project Consent Form 23MAR2015
School Absentee Reporting Form	None	Absentee Reporting Form - Survey of Parent or Child 24MAR2015
Sentinel Family Cohort Intake Form	None	Cohort Intake Form
Sentinel Family Cohort Weekly Illness Report	None	Cohort Weekly Illness Report

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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	26,120	0	0	26,120	0	0
Annual Time Burden (Hours)	2,062	0	0	2,062	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: 0920-14AYK submission is a NEW Information Collection Request

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Annual Cost to Federal Government: $536,000

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: 01/08/2015

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