Community Assessment for Public Health Emergency Response (CASPER)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Community Assessment for Public Health Emergency Response (CASPER) addressing the California Drought – Mariposa County, 2016	Form and Instruction	New	Available
Flood-Related Community Assessment for Public Health Emergency Response (CASPER) – WV, 2016	Form and Instruction	Unchanged	Available
Attachment H_Burden Memo_final.docx	Supplementary Document	Uploaded 2016-09-14	Available
InstrumentsFY16Q3.docx	Supplementary Document	Uploaded 2016-09-14	Available
0920-1036 Change Request Justification FY2016 Q3.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2016-09-14	Available
N_WeightAnalyses 12082014 Clean.docx	Supplementary Document	Uploaded 2014-12-10	Repair queued
AttachM_SamplePaper.pdf	Supplementary Document	Uploaded 2014-06-05	Available
AttachL_SamplePressRelease.pdf	Supplementary Document	Uploaded 2014-06-05	Available
AttachK_SampleFrameAndMap.docx	Supplementary Document	Uploaded 2014-06-05	Available
AttachJ_SampleIntroAndConsent.docx	Supplementary Document	Uploaded 2014-06-05	Repair queued
I StpsCndctng 12052014 Clean.docx	Supplementary Document	Uploaded 2014-12-10	Available
AttachH_Burden Memo.docx	Supplementary Document	Uploaded 2014-06-05	Repair queued
G RqstAprvl 12052014 Clean.docx	Supplementary Document	Uploaded 2014-12-10	Repair queued
AttachF_SampleFinalReport.pdf	Supplementary Document	Uploaded 2014-06-05	Available
AttachE_SampleReferralForm.pdf	Supplementary Document	Uploaded 2014-06-05	Available
AttachD_SampleTrackingForm.pdf	Supplementary Document	Uploaded 2014-06-05	Available
C SmplQnr 12052014 Clean.docx	Supplementary Document	Uploaded 2014-12-10	Available
AttachB_60dayFRN.pdf	Supplementary Document	Uploaded 2014-06-05	Available
AttachA_AuthLegis.pdf	Supplementary Document	Uploaded 2014-06-05	Available
CASPER SupStB 12082014 Clean.docx	Supporting Statement B	Uploaded 2014-12-10	Available
CASPER SupStA 12052014 Clean.docx	Supporting Statement A	Uploaded 2014-12-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
223813	Community Assessment for Public Health Emergency Response (CASPER) addressing the California Drought – Mariposa County, 2016	Form and Instruction	New
222058	Flood-Related Community Assessment for Public Health Emergency Response (CASPER) – WV, 2016	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-1036	ICR Reference No: 201609-0920-010
Status: Historical Active	Previous ICR Reference No: 201406-0920-005
Agency/Subagency: HHS/CDC	Agency Tracking No: 16BDY
Title: Community Assessment for Public Health Emergency Response (CASPER)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/19/2016
	Date Received in OIRA: 09/16/2016
Terms of Clearance: Previous terms continue: The agency is reminded that If a 24- or 72-hour OMB approval is requested, an explanation must be provided as to why it is needed. Specifically, CDC must make a case as to why collection must begin within 24 to 72 hours, and it must be related to a public health need.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	12/31/2017	12/31/2017
Responses	9,600	0	9,600
Time Burden (Hours)	4,731	0	4,731
Cost Burden (Dollars)	0	0	0

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Abstract: Community Assessment for Public Health Emergency Response (CASPER) is an effective public health tool designed to quickly provide low-cost, household-based information about a community's needs and health status in a simple, easy-to-understand format for decision-makers. CASPER uses well established, valid epidemiological methods to determine the health status and basic needs of the affected community, allowing officials to prioritize responses and make informed decisions regarding the distribution of resources. This change request contains the quarterly inventory of burden and instruments.

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Authorizing Statute(s): US Code: 42 USC 241 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:
	79 FR 18553	04/02/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 32959	06/09/2014
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
Community Assessment for Public Health Emergency Response (CASPER) addressing the California Drought – Mariposa County, 2016	NA, NA	Questionnaire - Drought Community Assessment for Public Health Emergency Response -- 2016 ,   Referral - Community Assessment for Public Health Emergency Response To Drought
Flood-Related Community Assessment for Public Health Emergency Response (CASPER) – WV, 2016	NA, NA	WV Flood 2016 CASPER Questionnaire ,   WV Flood 2016 CASPER Referral Form

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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	9,600	9,600	0	0	0	0
Annual Time Burden (Hours)	4,731	4,731	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: This is a new Generic ICR.

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Annual Cost to Federal Government: $98,328

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 09/16/2016

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