Early Hearing Detection and Intervention Hearing Screening and Follow-up survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Early Hearing Detecton and Intervention Hearing Screening and Follow-up survey	Form and Instruction	Removed	Available
Form CDC EHDI Hearing S Att 4B_CDC EHDI Hearing Screening and Follow-up Survey (HSFS)	Form and Instruction	New	Available
Att 6_Proposed Data Reports.docx	Supplementary Document	Uploaded 2017-03-09	Available
Att 5_DSHPSHWA Annual Survey2013_screenshots_Rev.pdf	Supplementary Document	Uploaded 2017-03-09	Available
Att 3_National EHDI Goals.docx	Supplementary Document	Uploaded 2017-03-08	Available
Att 2_60 Day FRN.pdf	Supplementary Document	Uploaded 2017-03-08	Available
SupSta B_EHDI.doc	Supporting Statement B	Uploaded 2017-03-08	Available
Attach_1_2016_B.docx	Supplementary Document	Uploaded 2017-02-27	Available
SupSta A_EHDI_030817.docm	Supporting Statement A	Uploaded 2017-03-09	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43622	Early Hearing Detecton and Intervention Hearing Screening and Follow-up survey	Form and Instruction	Removed
226006	Att 4B_CDC EHDI Hearing Screening and Follow-up Survey (HSFS)	Form and Instruction	New
207643	Att 4A)_CDC EHDI (HSFS) Directions	Instruction	Modified

ICR Details

OMB Control No: 0920-0733	ICR Reference No: 201702-0920-015
Status: Historical Active	Previous ICR Reference No: 201307-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No: 19917
Title: Early Hearing Detection and Intervention Hearing Screening and Follow-up survey
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/19/2017
	Date Received in OIRA: 03/10/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2020	36 Months From Approved	08/31/2016
Responses	116	0	55
Time Burden (Hours)	238	0	220
Cost Burden (Dollars)	0	0	0

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Abstract: This purpose of this data collection is to obtain standardized annual jurisdictional data related to the number of children screened for hearing loss, referred for and receiving follow-up testing, such as diagnostic audiologic evaluation.

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Authorizing Statute(s): PL: Pub.L. 42 - 247 317 Name of Law: Children's Health Act
   PL: Pub.L. 42 - 247 399 Name of Law: Children's Health Act of 2000
   PL: Pub.L. 42 - 241 301 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 69530	10/06/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 11577	02/24/2017
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
Att 4B_CDC EHDI Hearing Screening and Follow-up Survey (HSFS)	CDC EHDI Hearing Screening and Follow-up Survey	CDC
Early Hearing Detecton and Intervention Hearing Screening and Follow-up survey	None, None	Screenshots for CDC EHDI Hearing Screening and Follow-up Survey (HSFS) ,   CDC EHDI Hearing Screening and Follow-up Survey (HSFS)
Att 4A)_CDC EHDI (HSFS) Directions

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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	116	55	0	61	0	0
Annual Time Burden (Hours)	238	220	0	18	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The proposed revisions to the HSFS are designed to provide more complete and standardized information about the receipt of recommended EHDI services and the reasons about why some infants are loss to follow-up. Continued use of the HSFS, with the proposed revisions, will ensure that the CDC EHDI team is able to continue monitoring progress towards national EHDI goals, disseminate information to stakeholders, assess progress towards meeting Healthy People 2020 goals related to EHDI, measure progress towards Funding Opportunity Announcement (FOA) objectives, and guide the provision of technical assistance.

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Annual Cost to Federal Government: $8,890

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: 03/10/2017

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