DELTA FOCUS Program Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
DELTA FOCUS Survey	Form	Modified	Available
Attachment F_List of New Survey Items.docx	Supplementary Document	Uploaded 2016-05-25	Available
Attachment D_ IRB Determination- Evaluation Contract.pdf	Supplementary Document	Uploaded 2016-05-25	Available
Attachment C2-PublicComment_0984.pdf	Supplementary Document	Uploaded 2016-05-25	Available
Attachment C1-60Dy_FRN_0984Delta.pdf	Supplementary Document	Uploaded 2016-05-25	Available
Attachment B - Authorizing Legislation (DELTA).docx	Supplementary Document	Uploaded 2016-05-25	Available
Attachment A - Authorizing Legislation (FVPSA).docx	Supplementary Document	Uploaded 2016-05-25	Available
SSB_0984Delta_ICRO_52016.docx	Supporting Statement B	Uploaded 2016-05-25	Available
SSA_9084Delta_Clean_11-22-2016.docx	Supporting Statement A	Uploaded 2016-11-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
207693	DELTA FOCUS Survey	Form	Modified

ICR Details

OMB Control No: 0920-0984	ICR Reference No: 201605-0920-013
Status: Historical Active	Previous ICR Reference No: 201307-0920-006
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: DELTA FOCUS Program Evaluation
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/23/2016
	Date Received in OIRA: 06/03/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2019	36 Months From Approved
Responses	59	0	0
Time Burden (Hours)	59	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The Centers for Disease Control and Prevention seeks approval to reinstate an information collection to evaluate awardees under the DELTA FOCUS (Domestic Violence Prevention Enhancement and Leadership Through Alliances, Focusing on Outcomes for Communities United with States) program.

---

Authorizing Statute(s): US Code: 42 USC 201 Name of Law: Family Violence Prevention and Services
   US Code: 42 USC 314 Name of Law: Domestic Violence Prevention Enhancement Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 11800	03/07/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 34342	05/31/2016
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
DELTA FOCUS Survey	none	DELTA FOCUS survey

---

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	59	0	0	59	0	0
Annual Time Burden (Hours)	59	0	0	59	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: The number of respondents has increased to allow all coalition staff affiliated with the DELTA FOCUS project to participate in the data collection. Minor changes have been made to the information collection instrument.

---

Annual Cost to Federal Government: $237,549

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

---

Common Form ICR:  No

---

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: 06/03/2016

---