Preventive Health and Health Services Block Grant

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
SupSta B-Block Grant ICR.docx	Supporting Statement B	Uploaded 2016-05-27	Available
SupSta A-Block Grant ICR (1).docx	Supporting Statement A	Uploaded 2016-05-27	Available
Att 3_List_of_FY_2016_Awardees.docx	Supplementary Document	Uploaded 2016-05-23	Available
Att 2_60d FRN Block Grant.pdf	Supplementary Document	Uploaded 2016-05-23	Available
Att 1C_45_CFR_96[1].pdf	Supplementary Document	Uploaded 2016-05-23	Available
Att 1B_PL102-531[1].pdf	Supplementary Document	Uploaded 2016-05-23	Available
Att 1A_42_USC_300w.doc	Supplementary Document	Uploaded 2016-05-23	Available
Att 5B_AnnualReportGuidance.doc	Supplementary Document	Uploaded 2016-05-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6636	Att 4A_Work Plan Instrument	Other-WORD	Modified
184866	Att 5A_Annual Report Instrument	Other-WORD	Modified

ICR Details

OMB Control No: 0920-0106	ICR Reference No: 201605-0920-015
Status: Historical Active	Previous ICR Reference No: 201307-0920-005
Agency/Subagency: HHS/CDC	Agency Tracking No: 19896
Title: Preventive Health and Health Services Block Grant
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/25/2016
	Date Received in OIRA: 05/27/2016
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	08/31/2016
Responses	122	0	122
Time Burden (Hours)	2,135	0	2,135
Cost Burden (Dollars)	0	0	0

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Abstract: CDC currently provides Block Grant funding to 61 states, territories and tribal organizations, and collections Work Plans and Annual Reports to monitor their progress toward meeting Healthy People objectives, and to provide technical assistance. CDC requests OMB approval to continue information collection for two years. Information will be collected using a web-based MIS.

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Authorizing Statute(s): US Code: 42 USC 300w-300w-8 Name of Law: Preventive Health and Health Services Block Grants
   US Code: 45 USC 96.1-96.17 Name of Law: Block Grants
   PL: Pub.L. 102 - 531 101-104 Name of Law: Preventive Health and health Services Block Grant
  

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:
	81 FR 6274	02/05/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 32757	05/24/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Att 4A_Work Plan Instrument
Att 5A_Annual Report Instrument

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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	122	122	0	0	0	0
Annual Time Burden (Hours)	2,135	2,135	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:

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Annual Cost to Federal Government: $169,099

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? Yes

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: 05/27/2016

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