MONITORING AND REPORTING SYSTEM FOR THE PRESCRIPTION DRUG OVERDOSE PREVENTION FOR STATES COOPERATIVE AGREEMENT

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Annual reporting - Plan Tool	Form and Instruction	New	Available
Annual reporting - Progress Report Tool	Form and Instruction	New	Available
Initial population - Annual reporting - Progress Report Tool	Form and Instruction	New	Available
SSA_PDO15AUK _ 71916F.docx	Supporting Statement A	Uploaded 2016-07-29	Available
SSB_PDO15AUK_71916F.docx	Supporting Statement B	Uploaded 2016-07-29	Available
Att. 5 List of Awardees.docx	Supplementary Document	Uploaded 2016-07-28	Available
Att. 4 NCIPC Research Determination.pdf	Supplementary Document	Uploaded 2016-07-28	Available
Att. 2_FRN pdf PDO Monito.pdf	Supplementary Document	Uploaded 2016-07-28	Available
Att. 1 Authorizing Legislation.docx	Supplementary Document	Uploaded 2016-07-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
222748	Annual reporting - Plan Tool	Form and Instruction	New
222747	Annual reporting - Progress Report Tool	Form and Instruction	New
222746	Initial population - Annual reporting - Progress Report Tool	Form and Instruction	New

ICR Details

OMB Control No: 0920-1155	ICR Reference No: 201607-0920-014
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 15AUK
Title: MONITORING AND REPORTING SYSTEM FOR THE PRESCRIPTION DRUG OVERDOSE PREVENTION FOR STATES 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 without change	Conclusion Date: 01/19/2017
	Date Received in OIRA: 08/02/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2020	36 Months From Approved
Responses	87	0	0
Time Burden (Hours)	812	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This new information collection is needed to monitor cooperative agreement programs funded under the Prescription Drug Overdose Prevention for States. Information to be collected will provide crucial data for program performance monitoring and provide CDC with the capacity to respond to requests from DHHS.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: U.S. Public Health Service 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:
	80 FR 44965	07/28/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 48804	07/26/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Annual reporting - Progress Report Tool	NA	Annual reporting - Progress Report Tool
Initial population - Annual reporting - Progress Report Tool	NA	Initial population - Annual reporting - Progress Report Tool
Annual reporting - Plan Tool	NA	Annual reporting - Plan Tool

---

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	87	0	0	87	0	0
Annual Time Burden (Hours)	812	0	0	812	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: Submission of 0920-15AUK is a New ICR.

---

Annual Cost to Federal Government: $239,659

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: 08/02/2016

---