Assisted Reproductive Technology (ART) Program Reporting System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form C1b_v4 Att C1b_v4 NASS screens_04_17_2017_clean	Form and Instruction	Modified	Available
Form C1b_v3 Att C1b_v3 NASS screens	Form and Instruction	Modified	Available
Form C1b_v3 National ART Surveillance System NASS 2.) (Proposed for 2016)	Form	Modified	Available
Form C1b_v2 Att C1b v2 (Proposed) Future NASS screens for 2016	Form	Modified	Available
NASS	Form	Unchanged	Repair queued
Feedback Survey	Form	Unchanged	Available
OMB 0920-0556_change request 05.4.17.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-05-17	Available
OMB 0920-0556_change request 05.4.17.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-05-16	Available
0920-0556 Change Request Justification_09-16-2015.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-10-07	Available
SS Part B_01 23 2015.docx	Supporting Statement B	Uploaded 2015-02-12	Available
SS Part A_rev_07 13 2015.clean.docx	Supporting Statement A	Uploaded 2015-07-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43614	National ART Surveillance System	Form and Instruction	Modified	Att C1b_v4 NASS screens_04_17_2017_clean
43614	National ART Surveillance System	Form and Instruction	Modified	Att C1b_v3 NASS screens
43614	National ART Surveillance System	Form	Modified	National ART Surveillance System NASS 2.) (Proposed for 2016)
43614	National ART Surveillance System	Form	Modified	Att C1b v2 (Proposed) Future NASS screens for 2016
214986	ONe-time System Deployment	Form	Unchanged	NASS
203355	Feedback Survey	Form	Unchanged	Feedback Survey

ICR Details

OMB Control No: 0920-0556	ICR Reference No: 201705-0920-009
Status: Historical Active	Previous ICR Reference No: 201608-0920-007
Agency/Subagency: HHS/CDC	Agency Tracking No: 17AIV
Title: Assisted Reproductive Technology (ART) Program Reporting System
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 with change	Conclusion Date: 05/17/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/17/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2018	07/31/2018	07/31/2018
Responses	158,275	0	158,275
Time Burden (Hours)	117,740	0	116,425
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this change request is to explicitly incorporate these data elements into the approved screen shots, allowing for the most efficient capture of the previously approved information in relation to pregnancy success rates with minimal additional time burden. .

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Authorizing Statute(s): PL: Pub.L. 102 - 493 2 (a) Name of Law: Fertility Clinic Success Rate and Certification Act
   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:
	79 FR 42328	07/21/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 8659	02/18/2015
Did the Agency receive public comments on this ICR? Yes

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

table that charts list of burden

IC Title	Form No.	Form Name
Feedback Survey	none	Feedback Survey
National ART Surveillance System	C1b_v4, C1b_v2, C1b_v3, C1b_v3	Att C1b v2 (Proposed) Future NASS screens for 2016 ,   National ART Surveillance System NASS 2.) (Proposed for 2016) ,   Att C1b_v3 NASS screens ,   Att C1b_v4 NASS screens_04_17_2017_clean
ONe-time System Deployment	none	NASS

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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	158,275	158,275	0	0	0	0
Annual Time Burden (Hours)	117,740	116,425	0	1,315	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: The addition of two questions which are needed to capture to allow for complete linkage of embryo transfers to egg retrievals will add an additional burden of 0.2 minutes, thereby increasing the overall burden for this questionnaire by 30 minutes

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Annual Cost to Federal Government: $1,141,579

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: 05/17/2017

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