Improving the Understanding of Traumatic Brain Injury through Policy and Program Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Parent injury follow-up survey	Form	Unchanged	Available
Injury follow-up interview	Form	Unchanged	Available
Parent weekly surveillance survey	Form	Unchanged	Available
Athlete weekly surveillance report	Form	Unchanged	Available
Pre-season parent survey	Form	Unchanged	Available
Pre-season athlete survey	Form	Unchanged	Available
Pre-season coach survey	Form	Unchanged	Available
Change Request_Memo OMB#0920_1073.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-11-20	Available
Crosswalk OMB 11-19-15.xlsx	Supplementary Document	Uploaded 2015-11-20	Available
SSB_rev_2015-3-23-15 Revised 11-19-15.docx	Supporting Statement B	Uploaded 2015-11-20	Available
AttachQ_Law and Assoc Policy Character.docx	Supplementary Document	Uploaded 2015-03-30	Available
AttachP_Notification.docx	Supplementary Document	Uploaded 2015-03-30	Available
AttachO_Sample Table Shells.docx	Supplementary Document	Uploaded 2015-03-30	Available
Attachment N Consent forms 3-20.docx	Supplementary Document	Uploaded 2015-03-30	Available
AttachM - CSR USYSA Agreement.pdf	Supplementary Document	Uploaded 2015-03-30	Available
AttachL2 NCIPC Research Determination.pdf	Supplementary Document	Uploaded 2015-03-30	Available
AttachL1 IRB Approved letter Revised.pdf	Supplementary Document	Uploaded 2015-03-30	Available
AttachL IRB Approved letter.pdf	Supplementary Document	Uploaded 2015-03-30	Available
AttachK_Invitation letters_3-20.docx	Supplementary Document	Uploaded 2015-03-30	Available
AttachJ_Flyer_2-25.docx	Supplementary Document	Uploaded 2015-03-30	Available
AttachB1_Public Comment.docx	Supplementary Document	Uploaded 2015-03-30	Available
AttachB-60 day published notice_2014-09763.pdf	Supplementary Document	Uploaded 2015-03-30	Available
AttachA-Authorizing Legislation.docx	Supplementary Document	Uploaded 2015-03-30	Available
SSA_rev_2015-3-23-15.docx	Supporting Statement A	Uploaded 2015-03-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
215899	Parent injury follow-up survey	Form	Unchanged	Parent injury follow-up survey
215898	Athlete injury follow-up survey	Form	Unchanged	Injury follow-up interview
215897	Parent weekly surveillance report	Form	Unchanged	Parent weekly surveillance survey
215896	Athlete weekly surveillance report	Form	Unchanged	Athlete weekly surveillance report
215895	Pre-season parent survey	Form	Unchanged	Pre-season parent survey
215894	Pre-season athlete survey	Form	Unchanged	Pre-season athlete survey
215893	Pre-season coach survey	Form	Unchanged	Pre-season coach survey

ICR Details

OMB Control No: 0920-1073	ICR Reference No: 201511-0920-011
Status: Historical Active	Previous ICR Reference No: 201503-0920-018
Agency/Subagency: HHS/CDC	Agency Tracking No: 16FH
Title: Improving the Understanding of Traumatic Brain Injury through Policy and Program Evaluation
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/01/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/25/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2018	06/30/2018	06/30/2018
Responses	35,956	0	35,956
Time Burden (Hours)	2,452	0	2,452
Cost Burden (Dollars)	0	0	0

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Abstract: To determine whether the return-to-play policies followed by club soccer teams make a difference in the proportion of boys and girls ages 14 -18 who return to play with symptoms after a concussion injury, and to assess the relationship between CDC's Heads Up Initiative and concussion knowledge among youth soccer coaches, parents, and athletes. To improve efforts focused on youth athlete concussion prevention, evaluation, and management. The Change Request is for the removal of an endorsement letter from the USYSA. There are no changes to any of the information collection instruments, Burden Hours or Respondents.

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Authorizing Statute(s): US Code: 42 USC 241 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 24431	04/30/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 59271	10/01/2014
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
Athlete injury follow-up survey	none	Injury follow-up interview
Athlete weekly surveillance report	none	Athlete weekly surveillance report
Parent injury follow-up survey	none	Parent injury follow-up survey
Parent weekly surveillance report	none	Parent weekly surveillance survey
Pre-season athlete survey	none	Pre-season athlete survey
Pre-season coach survey	none	Pre-season coach survey
Pre-season parent survey	none	Pre-season parent survey

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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	35,956	35,956	0	0	0	0
Annual Time Burden (Hours)	2,452	2,452	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a resubmission of a new ICR.

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Annual Cost to Federal Government: $707,281

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: 11/25/2015

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