Poison Center Collaborations for Public Health Emergencies

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-1166 Identifying Sources of and Risk Factors for Harmful Algal Bloom Exposures through Poison Control Center Follow-up Questionnaires – United States, 2019	Form	New	Available
Att14 Smpl Dtst for Qstnnr PCCPHE.xlsx	Supplementary Document	Uploaded 2016-09-07	Available
Att13 NCEH-ATSDR RDF PCCPHE.pdf	Supplementary Document	Uploaded 2016-09-07	Available
Att12 Burden Memo PCCPHE.docx	Supplementary Document	Uploaded 2016-09-07	Available
Att11 Sample Questionnaire Parent PCCPHE.docx	Supplementary Document	Uploaded 2016-09-07	Available
Att10 Sample Questionnaire Adolescent PCCPHE.docx	Supplementary Document	Uploaded 2016-09-07	Available
Att9 Sample Questionnaire Adult PCCPHE.docx	Supplementary Document	Uploaded 2016-09-07	Available
Att8 Sample Consent and Assent Forms PCCPHE.docx	Supplementary Document	Uploaded 2016-09-07	Available
Att7 GenIC Rqst Apprvl Form PCCPHE.docx	Supplementary Document	Uploaded 2016-09-07	Available
Att6 Advncd Ntifictn Emil for OMB PCCPHE.docx	Supplementary Document	Uploaded 2016-09-07	Available
Att5 Step-by-StepHowtoUsetheGenericClrnce PCCPHE.docx	Supplementary Document	Uploaded 2016-09-07	Available
Att4 CDC-AAPCC DataLicAgremt 2016_signed.pdf	Supplementary Document	Uploaded 2016-09-07	Repair queued
Att3 Map of US Poison Centers.pdf	Supplementary Document	Uploaded 2016-09-07	Available
Att2 60-day FRN PCCPHE.pdf	Supplementary Document	Uploaded 2016-09-07	Available
Att1 Authorizing Legislation.pdf	Supplementary Document	Uploaded 2016-09-07	Available
SSB PPCCPHE.docx	Supporting Statement B	Uploaded 2016-09-07	Available
SSA PPCCPHE Clean.docx	Supporting Statement A	Uploaded 2017-02-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
237171	Identifying Sources of and Risk Factors for Harmful Algal Bloom Exposures through Poison Control Center Follow-up Questionnaires – United States, 2019	Form	New

ICR Details

OMB Control No: 0920-1166	ICR Reference No: 201609-0920-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 16ARH
Title: Poison Center Collaborations for Public Health Emergencies
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: 02/17/2017
	Date Received in OIRA: 09/13/2016
Terms of Clearance: Approved consistent with the understanding that GenICs under this generic will be limited to follow-up activities in response to acute public health emergencies that may be causing adverse health outcomes. Data collection for investigations conducted under this generic will not exceed 60 days. Investigations conducted for the primary purpose of program evaluation, surveillance, needs assessment, or research (e.g., to contribute to generalizable knowledge) are excluded from this generic pathway. Al GenICs submitted under this generic will include all information collection instruments and an abbreviated supporting statement part A.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2020	36 Months From Approved
Responses	900	0	0
Time Burden (Hours)	600	0	0
Cost Burden (Dollars)	12,696	0	0

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Abstract: The goal of this generic collection is to create a timely mechanism to allow poison centers, supported by CDC, to obtain critical exposure and health information during a public health emergency. For selected events, poison center staff with CDC collaboration will conduct a call-back questionnaire to include questions not asked during initial poison center calls but are important for public health response to reduce mortality and morbidity.

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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:
	81 FR 40698	06/22/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 62740	09/12/2016
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Identifying Sources of and Risk Factors for Harmful Algal Bloom Exposures through Poison Control Center Follow-up Questionnaires – United States, 2019	0920-1166, 0920-1166, 0920-1166	Follow-up questionnaire for individuals calling poison control centers (PCCs) regarding exposures to harmful algal blooms (HABs) – ADULT ,   Follow-up questionnaire for individuals calling poison control centers (PCCs) regarding exposures to harmful algal blooms (HABs) – ADOLESCENT ,   Follow-up questionnaire for individuals calling poison control centers (PCCs) regarding exposures to harmful algal blooms (HABs) – PARENT-CHILD

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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	900	0	0	900	0	0
Annual Time Burden (Hours)	600	0	0	600	0	0
Annual Cost Burden (Dollars)	12,696	0	0	12,696	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 generic clearance request.

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Annual Cost to Federal Government: $122,784

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: 09/13/2016

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