A Comprehensive Assessment of the National Program to Eliminate Diabetes Related Health Disparities in Vulnerable Populations

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Community Partner Interview Guide	Form and Instruction	New	Available
Site Coordinator Interview	Form and Instruction	New	Available
Grantee Interview	Form and Instruction	New	Available
Att 9 VP IRB Approval Form.pdf	Supplementary Document	Uploaded 2015-03-05	Available
Att 8 VP Interview Reminder_2 13 2015.docx	Supplementary Document	Uploaded 2015-03-05	Available
Att 7 VP Email Invitation_3 02 2015.doc	Supplementary Document	Uploaded 2015-03-05	Available
Att 3 Summary of Public Comments.doc	Supplementary Document	Uploaded 2015-03-05	Available
Att 2 60-day FRN 10 07 2014.pdf	Supplementary Document	Uploaded 2015-03-05	Available
Att 1 Public Health Service Act.doc	Supplementary Document	Uploaded 2015-03-05	Available
SS B_2 13 2015.docx	Supporting Statement B	Uploaded 2015-03-05	Available
SS A_3 02 2015.docx	Supporting Statement A	Uploaded 2015-03-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
215617	Community Partner Interview Guide	Form and Instruction	New
215533	Site Coordinator Interview	Form and Instruction	New
215529	Grantee Interview	Form and Instruction	New

ICR Details

OMB Control No: 0920-1070	ICR Reference No: 201503-0920-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 14BAA
Title: A Comprehensive Assessment of the National Program to Eliminate Diabetes Related Health Disparities in Vulnerable Populations
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 without change	Conclusion Date: 06/09/2015
	Date Received in OIRA: 03/11/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2016	12 Months From Approved
Responses	48	0	0
Time Burden (Hours)	72	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Information will be collected to elucidate how 6 CDC-funded national organizations, working with 18 selected communities, are implementing strategies to eliminate diabetes disparities in communities with vulnerable populations. Semi-structured interviews will be conducted with respondents who are employed by the national organizations, and with respondents who are community partners or coalition members.

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Authorizing Statute(s): 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 60471	10/07/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 12644	03/10/2015
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Site Coordinator Interview	none	Site Coordinator Interview Guide
Community Partner Interview Guide	none	Community Partner Interview Guide
Grantee Interview	none	Grantee Interview Guide

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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	48	0	0	48	0	0
Annual Time Burden (Hours)	72	0	0	72	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: $77,750

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: 03/11/2015

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