DCH Awardee Training Needs Assessment

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
State/Local/Tribal Media Communication Lead	Form	New	Available
State/Local/Tribal Evaluation Lead	Form	New	Available
State/Local/Tribal Principal Investigators and Program Managers	Form	New	Available
Private Sector Coalition Member	Form	New	Available
Private Sector Media/Communication Lead	Form	New	Available
Private Sector Evaluation Lead	Form	New	Available
Private Sector Principal Investigators and Program Managers	Form	New	Available
SS A_rev6-26-15 clean.doc	Supporting Statement A	Uploaded 2015-07-01	Available
Attachment H_Thank You Email.docx	Supplementary Document	Uploaded 2015-04-09	Available
Attachment G_Final Reminder Email_3 27 2015_ICF.docx	Supplementary Document	Uploaded 2015-04-09	Available
Attachment F_Reminder Email_3 27 2015_ICF.docx	Supplementary Document	Uploaded 2015-04-09	Available
Attachment E_Initial Outreach Email_ 3 27 2015_ICF.docx	Supplementary Document	Uploaded 2015-04-09	Available
Attachment J_Telephone Interview Guide_rev7-01-15 clean.docx	Supplementary Document	Uploaded 2015-07-02	Available
SS B_rev6-26-15 clean.doc	Supporting Statement B	Uploaded 2015-07-01	Available
Attachment K_Respondent Matrix_rev6-26-15 clean.docx	Supplementary Document	Uploaded 2015-07-01	Available
Attachment D_ICF International IRB Approval Memorandum.pdf	Supplementary Document	Uploaded 2015-04-09	Available
Attachment C2_Summary of Public Comments.doc	Supplementary Document	Uploaded 2015-04-09	Available
Attachment C1_60-day FRN 11 07 2014.pdf	Supplementary Document	Uploaded 2015-04-09	Available
Attachment B_List of DCH PICH and REACH Awardees_3 27 2015_ICF.docx	Supplementary Document	Uploaded 2015-04-09	Available
Attachment A2_ACA PPHF.pdf	Supplementary Document	Uploaded 2015-04-09	Available
Attachment A1_Section 301 of the Public Health Service Act.pdf	Supplementary Document	Uploaded 2015-04-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
216034	State/Local/Tribal Media Communication Lead	Form	New
216033	State/Local/Tribal Evaluation Lead	Form	New
216032	State/Local/Tribal Principal Investigators and Program Managers	Form	New
216031	Private Sector Coalition Member	Form	New
216030	Private Sector Media/Communication Lead	Form	New
216029	Private Sector Evaluation Lead	Form	New
216028	Private Sector Principal Investigators and Program Managers	Form	New

ICR Details

OMB Control No: 0920-1076	ICR Reference No: 201504-0920-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 15DH
Title: DCH Awardee Training Needs Assessment
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: 07/09/2015
	Date Received in OIRA: 05/05/2015
Terms of Clearance: Per OIRA request, the Agency made the following amendments: - Uploaded new versions of SSA and SSB. - Replaced Attachment I (screenshots) in each respondent category. - Replaced Attachments J and K in the supplemental documents. Agency has requested approval for 2 years: "The DCH awardee training needs assessment will be administered twice: once during the third quarter of 2015 and once during the last quarter of 2016."

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	36 Months From Approved
Responses	352	0	0
Time Burden (Hours)	236	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC's Division of Community Health plans to collect information from cooperative agreement awardees and coalition members associated with these awardees, in order to assess and prioritize training needs.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 148 40002 Name of Law: Affordable Care 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 66379	11/07/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 22192	04/21/2015
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
State/Local/Tribal Principal Investigators and Program Managers	none	Training Needs Assessment
State/Local/Tribal Media Communication Lead	none	Training Needs Assessment
State/Local/Tribal Evaluation Lead	none	Training Needs Assessment
Private Sector Principal Investigators and Program Managers	none	Training Needs Assessment
Private Sector Evaluation Lead	none	Training Needs Assessment
Private Sector Media/Communication Lead	none	Training Needs Assessment
Private Sector Coalition Member	none	Training Needs Assessment

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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	352	0	0	352	0	0
Annual Time Burden (Hours)	236	0	0	236	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: $178,886

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: 05/05/2015

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