Monitoring and Reporting System for the Division of Community Health's Cooperative Agreement Programs

Forms and Documents

Document Name	Status
Private Sector - Special Data Request Form	New
Private Sector - Semi-annual Reporting Form	New
Private Sector - Initial population Form	New
State/Local/Tribal Sector - Special Data Reporting Form	New
State/Local/Tribal - Semi-annual reporting Form	New
State/Local/Tribal Sector-Initial population Form	New
Att 3b_DCH-PMB Guidance_3 06 2015.docx Supplementary Document	2015-03-10
SS Part B_03 06 2015.docx Supporting Statement B	2015-03-10
SS Part A_03 06 2015.docx Supporting Statement A	2015-03-10
Att 5_Federal Register Notice.pdf Supplementary Document	2015-01-12
Att 2_List of Awardees.docx Supplementary Document	2015-01-12
Att 1b_ACA PPHF.pdf Supplementary Document	2015-01-12
Att 1a_PHSA.pdf Supplementary Document	2015-01-12

IC Document Collections

IC ID	Document Title	Status
214570	Private Sector - Special Data Request Form	New
214569	Private Sector - Semi-annual Reporting Form	New
214568	Private Sector - Initial population Form	New
214567	State/Local/Tribal Sector - Special Data Reporting Form	New
214566	State/Local/Tribal - Semi-annual reporting Form	New
214565	State/Local/Tribal Sector-Initial population Form	New

ICR Details

OMB Control No: 0920-1053	ICR Reference No: 201501-0920-011
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 14AOO
Title: Monitoring and Reporting System for the Division of Community Health's Cooperative Agreement Programs
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: 03/10/2015
	Date Received in OIRA: 01/16/2015
Terms of Clearance: Non-substantive change requests will be approved only if the following conditions are met: the data requested is readily available to the awardee, the collection is low burden to the awardee (less than 30 minutes to compile and report the information), and it is related to existing data collected from awardees.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2018	36 Months From Approved
Responses	311	0	0
Time Burden (Hours)	1,596	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC plans to collection information from awardees funded under the Division of Community Health. Awardees will report progress and activity information to CDC using an electronic Management Information System. Reports are due twice per year but updates can be entered at any time. Approval is requested for three years.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 4002 Name of Law: Patient Protection and Affordable Care Act
   US Code: 42 USC 241 Name of Law: PHSA
  

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 41691	07/17/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 1636	01/13/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
State/Local/Tribal - Semi-annual reporting	none	DCH Screenshots
State/Local/Tribal Sector-Initial population	none	DCH Screenshots
State/Local/Tribal Sector - Special Data Reporting	none	Special Data Request
Private Sector - Initial population	none	DCH Screenshots
Private Sector - Semi-annual Reporting	none	DCH Screenshots
Private Sector - Special Data Request	none	Special Data Request

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ICR Summary 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	311	0	0	311	0	0
Annual Time Burden (Hours)	1,596	0	0	1,596	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 ICR.

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Annual Cost to Federal Government: $178,864

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]? 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

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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: 01/16/2015

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