Justification for Change

Non-Substantive Change Request to OMB Control No. 0920-1122: Congenital Heart Survey to Recognize Outcomes, Needs,

and Well-Being.

Program Contact

Sherry Farr, PhD

National Center for Birth Defects and Developmental Disabilities (NCBDDD)

Birth Defects Branch

1600 Clifton Rd, E-86

Atlanta GA 30333

Submission Date: January 23, 2021

Circumstances of Change Request for OMB 0920-1122

CDC requests approval for a non-substantive change to OMB Control No. 0920-1122: Congenital Heart Survey to Recognize Outcomes, Needs, and Well-Being.

These changes are being made to add one question to the survey instrument (#29).

Estimates of annualized burden hours for this change request remain the same. The burden estimate for the forms included in OMB Control No. 0920-1122 is 1,558 hours for the entire survey.

Description and Justification of Changes

Attachments 3 (English) and 12 (Spanish): CH STRONG Survey

Question #29 regarding non-heart-defect comorbidities has been added to the survey instrument. The purpose of this question is to collect data on other conditions, besides an individual's congential heart defect, that could potentially influence his or her responses regarding quality of life and healthcare utilization. Little is known about comorbid conditions among young adults with CHD.

Listed below is the question to be added to the survey in English and Spanish.

The next few questions ask about your physical and mental health and your interactions with others.

1. Have you ever been told by a doctor or other health professional that you had any of the following conditions (Check all that apply.):

1. Diabetes or sugar diabetes?                                                                       

2. Obstructive sleep apnea?

3. Cancer or a malignancy of any kind?

4. Congestive heart failure?

5. Cardiac dysrhythmias or irregular heart beat?

6. A mood disorder or depression?

7. A heart attack (also called myocardial infarction)?

8. A stroke?

9. Asthma?

10. An ulcer (stomach, duodenal or peptic ulcer)?

11. Arthritis, gout, lupus, or fibromyalgia?

12. Hypertension, also called high blood pressure?

13. Any other chronic illness that is expected to last at least 12 months?

Please specify.  _________________________

Estimates of Annualized Burden hours (unchanged from approved ICR)

Estimates of annualized burden hours for this change request remain the same. The burden estimate for the forms included in OMB Control No. 0920-1118 is 892 hours for the overall assessment, 67 hours of which are estimated for the Case-Control Interview section (Project 2).

Type of Respondent	Form Name	No. of Respondents	No. of Responses per Respondent	Average Burden per Response	Total Burden Hours
Individuals aged 18-45 years who were born with a congenital heart defect	Survey questionnaire	4,672	1	20/60	1,558

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