Monitoring and Reporting for the Core State Violence and Injury Prevention Program Cooperative Agreement

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Attachment B2_public comment.pdf	Supplementary Document	Uploaded 2016-07-01	Available
published 30d FRN.pdf	Supplementary Document	Uploaded 2016-03-04	Available
IRB-NCIPC ResearchDetr_Core_SVIPP_Sign.pdf	Supplementary Document	Uploaded 2016-03-03	Available
Att B_60 Dy FRN CORE SVIPP.pdf	Supplementary Document	Uploaded 2016-03-02	Available
Att A_Public Health Service Act.pdf	Supplementary Document	Uploaded 2016-03-02	Available
SSB_CoreSVIPP_021116.docx	Supporting Statement B	Uploaded 2016-03-02	Available
Monitoring and Reporting CoreSVIPP_SSA_CoreSVIPP 022916_OMB_6-30.docx	Supporting Statement A	Uploaded 2016-07-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
220460	2-Enhanced Component -Injury Indicator	Other-WORD	New
220459	2-Enhanced Component -Evaluation and Performance Managment Plan	Other-WORD	New
220458	2-Enhanced Component -Annual Progress Report	Other-WORD	New
220451	2-Enhanced Component -Initial Population-Annual Progress Report	Other-WORD	New
220446	1-Enhanced Component -Injury Indicator	Other-WORD	New
220445	1-Enhanced Component -Evaluation and Performance Management Plan	Other-WORD	New
220444	1-Enhanced Component -Annual Progress Report	Other-WORD	New
220424	1-Enhanced_Initial Population- Annual Progress Report	Other-WORD	New
220420	BASE -Injury Indicator	Other-WORD	New
220415	BASE -Evaluation and Performance Mgmt Plan	Other-WORD	New
220413	BASE -Annual Progress Report	Other-WORD	New
220409	BASE -Annual Progress Report -Intial Population	Other-WORD	New

ICR Details

OMB Control No: 0920-1120	ICR Reference No: 201603-0920-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 16BZ
Title: Monitoring and Reporting for the Core State Violence and Injury Prevention Program Cooperative Agreement
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: 07/05/2016
	Date Received in OIRA: 03/07/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2019	36 Months From Approved
Responses	120	0	0
Time Burden (Hours)	3,120	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Collect information needed to monitor cooperative agreement programs funded under the Core State Violence and Injury Prevention Program (Core SVIPP) (CDC-RFA-CE16-1602). Information to be collected will provide crucial data for program performance monitoring and provide CDC with the capacity to respond to requests from DHHS.

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Authorizing Statute(s): US Code: 42 USC 301 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:
	80 FR 69225	11/09/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 11568	03/04/2016
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 12

table that charts list of burden

IC Title	Form No.	Form Name
BASE -Annual Progress Report -Intial Population
2-Enhanced Component -Annual Progress Report
2-Enhanced Component -Evaluation and Performance Managment Plan
1-Enhanced_Initial Population- Annual Progress Report
1-Enhanced Component -Annual Progress Report
2-Enhanced Component -Injury Indicator
BASE -Annual Progress Report
BASE -Injury Indicator
2-Enhanced Component -Initial Population-Annual Progress Report
1-Enhanced Component -Evaluation and Performance Management Plan
1-Enhanced Component -Injury Indicator
BASE -Evaluation and Performance Mgmt Plan

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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	120	0	0	120	0	0
Annual Time Burden (Hours)	3,120	0	0	3,120	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 collection request for a new OMB Control Number

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Annual Cost to Federal Government: $242,723

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: 03/07/2016

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