CDC Oral Health Management Information System

Forms and Documents

Document Name	Status
Enhanced level awardees - Annual progress report Form	Modified
Enhanced level awardees - Initial MIS load Form	Removed
Basic level awardees - Annual progress report Form	Modified
Basic level awardees - Initial MIS population Form	Removed
0920-0739 IRB Form 684_DOH_approved_final.pdf Supplementary Document	2017-08-03
Att 4. Performance Measures and Data Elements.docx Supplementary Document	2017-08-03
Att 3. Awardees.docx Supplementary Document	2017-08-03
Att 2. 60-day FRN.PDF Supplementary Document	2017-08-03
Att 1. PHSA.DOC Supplementary Document	2017-08-03
0920-0739 Revision Request Supporting Statement B_DOH_6_29_2017.doc Supporting Statement B	2017-08-03
0920-0739 Revision Request Supporting Statement A_DOH_7_26_2017.doc Supporting Statement A	2017-08-03

IC Document Collections

IC ID	Document Title	Status
210883	Enhanced level awardees - Annual progress report Form	Modified
210882	Enhanced level awardees - Initial MIS load Form	Removed
210881	Basic level awardees - Annual progress report Form	Modified
178975	Basic level awardees - Initial MIS population Form	Removed

ICR Details

OMB Control No: 0920-0739	ICR Reference No: 201708-0920-005
Status: Historical Active	Previous ICR Reference No: 201403-0920-012
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0739
Title: CDC Oral Health Management Information System
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/25/2017
	Date Received in OIRA: 08/21/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2019	24 Months From Approved	05/22/2017
Responses	21	0	7
Time Burden (Hours)	171	0	84
Cost Burden (Dollars)	0	0	0

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Abstract: The CDC Oral Health Management Information System helps state awardees organize their oral health program information and efficiently generate progress reports. CDC requests a reinstatement with change to continue collecting information for two more years to allow CDC to collect final progress and evaluation report data. Changes include minor edits to the user interface and the removal of the initial system information population.

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Authorizing Statute(s): US Code: 42 USC 247(b)(k)(2) Name of Law: null
   US Code: 42 USC 301 Name of Law: PHSA
   US Code: 42 USC 241(a) Name of Law: Research and Investigation in General
  

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:
	82 FR 6554	01/19/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 39585	08/21/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Basic level awardees - Annual progress report	none	Chronic disease management system
Enhanced level awardees - Initial MIS load	none	Chronic Disease MIS
Enhanced level awardees - Annual progress report	none	Chronic disease management system
Basic level awardees - Initial MIS population	none	Chronic Disease MIS

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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	21	7	0	14	0	0
Annual Time Burden (Hours)	171	84	0	87	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 initial MIS population is no longer necessary resulting in the decrease in burden for the last two years of the program. Minor edits were made to the MIS with no resulting change in burden.

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Annual Cost to Federal Government: $46,800

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 08/21/2017

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