ATSDR Communication Activities Survey (ACAS)

Forms and Documents

Document Name	Status
Agency Stakeholders - ACAS Telephone Form and Instruction	New
Agency Stakeholders - ACAS Online Form and Instruction	New
Agency Stakeholders - ACAS Hard Copy Form and Instruction	New
Agency Stakeholders - ACAS Sign-In Sheet Form and Instruction	New
Community Members - ACAS Telephone Form and Instruction	New
Community Members - ACAS Online Form and Instruction	New
Community Members - ACAS Hard Copy Form and Instruction	New
Community Members - Sign-In Sheet Form and Instruction	New
AttE1 Sign-In Sheet Aid 20170612 clean.docx Supplementary Document	2017-06-16
ACAS SSB 06122017 clean.docx Supporting Statement B	2017-06-16
ACAS SSA 16JUN2017.docx Supporting Statement A	2017-06-19
AttI ACAS Research Determination.pdf Supplementary Document	2016-12-15
AttH Thank You Letter for Community Members.doc Supplementary Document	2016-12-15
AttG Reminder Emails for Online Survey.doc Supplementary Document	2016-12-15
AttF Initial Email for Online Survey Link.doc Supplementary Document	2016-12-15
AttD Communty Mtng Fact Sheet 20170615 clean.docx Supplementary Document	2017-06-16
AttB ACAS 60-day FRN 20160926.pdf Supplementary Document	2016-12-15
AttA3 SARA AuthLegsl.pdf Supplementary Document	2016-12-15
AttA2 RCRA AuthLegsl.pdf Supplementary Document	2016-12-15
AttA1 CERCLA AuthLegsl.pdf Supplementary Document	2016-12-15

IC Document Collections

IC ID	Document Title	Status
224881	Agency Stakeholders - ACAS Telephone Form and Instruction	New
224880	Agency Stakeholders - ACAS Online Form and Instruction	New
224879	Agency Stakeholders - ACAS Hard Copy Form and Instruction	New
224878	Agency Stakeholders - ACAS Sign-In Sheet Form and Instruction	New
224874	Community Members - ACAS Telephone Form and Instruction	New
224873	Community Members - ACAS Online Form and Instruction	New
224872	Community Members - ACAS Hard Copy Form and Instruction	New
224871	Community Members - Sign-In Sheet Form and Instruction	New

ICR Details

OMB Control No: 0923-0055	ICR Reference No: 201612-0923-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/TSDR	Agency Tracking No: 0923-16BEH
Title: ATSDR Communication Activities Survey (ACAS)
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: 06/19/2017
	Date Received in OIRA: 01/05/2017
Terms of Clearance: Given the design of this ICR, it is not appropriate to use for GPRA or any other program evaluation metrics, and any use in this manner will prohibit the ICR from being renewed. The results, as indicated in the supporting statement, will only be used by ATSDR to standardize and ensure consistent delivery of ATSDR activities, improve implementation of activities, and help ATSDR and communities understand and improve ATSDR activities.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2020	36 Months From Approved
Responses	334	0	0
Time Burden (Hours)	49	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The ACAS will be used to ascertain the effectiveness, and to evaluate the differences and consistency, of ATSDR activity delivery and respondent perceptions across sites and over time; determine how effectively ATSDR's site team engages community members; and discover how well ATSDR provides effective, clear and consistent communication and information on how to promote healthy and safe environments and prevent harmful exposures through the activities they implement in communities.

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Authorizing Statute(s): PL: Pub.L. 107 - 377 101 Name of Law: Comprehensive Environmental Response, Compensation and Liability Act (CERCLA)
   PL: Pub.L. 107 - 377 1001 Name of Law: Solid Waste Disposal Act
   PL: Pub.L. 107 - 377 118 Name of Law: Superfund Amendments and Reauthorization Act (SARA)
  

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 66024	09/26/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 95998	12/29/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

IC Title	Form No.	Form Name
Community Members - Sign-In Sheet	NA	ATSDR Public Meeting Sign-In Sheet
Agency Stakeholders - ACAS Hard Copy	NA	ATSDR Community Activities Survey - Hardcopy
Agency Stakeholders - ACAS Online	NA	ATSDR Community Activities Survey - Online
Agency Stakeholders - ACAS Telephone	NA	ATSDR Community Activities Survey - Telephone
Agency Stakeholders - ACAS Sign-In Sheet	NA	ATSDR Public Meeting Sign-In Sheet
Community Members - ACAS Hard Copy	NA, NA	ATSDR Community Activities Survey - Hardcopy
Community Members - ACAS Online	NA	ATSDR Community Activities Survey - Online
Community Members - ACAS Telephone	NA	ATSDR Community Activities Survey - Telephone

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ICR Summary 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	334	0	0	334	0	0
Annual Time Burden (Hours)	49	0	0	49	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 0923-16BEH is a New ICR.

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Annual Cost to Federal Government: $155,167

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: 01/05/2017

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