Paul Coverdell National Acute Stroke Program (PCNASP) Reporting System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Hospital Inventory Data - PCNASP Awardee	Form and Instruction	New	Available
Post-Hospital Quality of Care Data - PCNASP Awardee	Form and Instruction	New	Repair queued
In-Hospital Quality of Care Data - PCNASP Awardee	Form and Instruction	New	Available
Pre-Hospital Quality of Care Data - PCNASP Awardee	Form and Instruction	New	Available
Hospital Inventory Data - Hospital Partners	Form and Instruction	New	Available
Post-Hospital Quality of Care Data - Hospital Partners	Form and Instruction	New	Available
Pre-Hospital Quality of Care Data - Hospital Partners	Form and Instruction	New	Repair queued
Attachment 1_Data Burden Estimate.docx	Supplementary Document	Uploaded 2015-12-02	Available
Attachment 9_Screenshot SAMS web portal.pdf	Supplementary Document	Uploaded 2015-12-02	Available
Attachment 11_PCNASP Quarterly Performance Measure Results.docx	Supplementary Document	Uploaded 2015-12-01	Available
Attachment 10_PCNASP Awardees.docx	Supplementary Document	Uploaded 2015-12-01	Repair queued
Attachment 6_Collection and transmission diagram.docx	Supplementary Document	Uploaded 2015-12-01	Available
Attachment 8_IRB approval letter.docx	Supplementary Document	Uploaded 2015-12-01	Available
Attachment 3b_Crosswalk outcomes, measures, data sources.docx	Supplementary Document	Uploaded 2015-12-01	Available
Attachment 3a_Crosswalk aims and outcomes.docx	Supplementary Document	Uploaded 2015-12-01	Available
Attachment 7_Federal Register Notice.pdf	Supplementary Document	Uploaded 2015-12-01	Available
Attachment 2_Section 317 Public Health Service Act.pdf	Supplementary Document	Uploaded 2015-12-01	Available
PCNASP OMB Part B_OMB_revised 03 24 16.docx	Supporting Statement B	Uploaded 2016-03-25	Available
PCNASP OMB Part A_OMB_revised 03 24 16.docx	Supporting Statement A	Uploaded 2016-03-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
219135	Hospital Inventory Data - PCNASP Awardee	Form and Instruction	New
219134	Post-Hospital Quality of Care Data - PCNASP Awardee	Form and Instruction	New
219132	In-Hospital Quality of Care Data - PCNASP Awardee	Form and Instruction	New
219131	Pre-Hospital Quality of Care Data - PCNASP Awardee	Form and Instruction	New
219130	Hospital Inventory Data - Hospital Partners	Form and Instruction	New
219129	Post-Hospital Quality of Care Data - Hospital Partners	Form and Instruction	New
219128	Pre-Hospital Quality of Care Data - Hospital Partners	Form and Instruction	New

ICR Details

OMB Control No: 0920-1108	ICR Reference No: 201511-0920-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 15AUJ
Title: Paul Coverdell National Acute Stroke Program (PCNASP) Reporting System
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: 03/25/2016
	Date Received in OIRA: 12/03/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2019	36 Months From Approved
Responses	824	0	0
Time Burden (Hours)	382	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The CDC's Paul Coverdell National Acute Stroke Program (PCNASP) seeks to improve quality of care for acute stroke patients through systematic approaches to quality improvement. CDC will work with selected state health departments to collect data and improve quality of care throughout the 3 phases of the stroke continuum of care: (1) pre-hospital care, (2) in-hospital care, and (3) post-discharge care. Information on infrastructure and hospital capacity will also be collected.

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Authorizing Statute(s): US Code: 42 USC 247 Name of Law: Publilc 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:
	80 FR 42820	07/20/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 73769	11/25/2015
Did the Agency receive public comments on this ICR? No

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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
Pre-Hospital Quality of Care Data - Hospital Partners	NA	PCNASP Pre-Hospital Data Elements
Post-Hospital Quality of Care Data - Hospital Partners	NA	PCNASP Post-Hospital Transition of Care Data Elements
Post-Hospital Quality of Care Data - PCNASP Awardee	NA	PCNASP Post-Hospital Transition of Care Data Elements
Hospital Inventory Data - Hospital Partners	NA	PCNASP Hospital Inventory Data Elements
Pre-Hospital Quality of Care Data - PCNASP Awardee	NA	PCNASP Pre-Hospital Data Elements
In-Hospital Quality of Care Data - PCNASP Awardee	NA	PCNASP In-Hospital Data Elements
Hospital Inventory Data - PCNASP Awardee	NA	PCNASP Hospital Inventory Data Elements - Awardee Reporting Tool

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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	824	0	0	824	0	0
Annual Time Burden (Hours)	382	0	0	382	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: Submission of Paul Coverdell National Acute Stroke Program (PCNASP) Reporting System - 0920-15AUJ - is a New ICR.

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Annual Cost to Federal Government: $6,771,710

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: 12/03/2015

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