Million Hearts Hypertension Control Challenge

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Attachment 5 Interview Guide	Form and Instruction	Unchanged	Available
Data Verification Form	Form and Instruction	Modified	Available
Application Form	Form and Instruction	Modified	Available
0920-0976 Change Request_08072017.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-08-07	Available
Attachment 9 Change request crosswalk_08072017.docx	Supplementary Document	Uploaded 2017-08-07	Available
Att 7 Revised Eligibility and Rules for Participation track changes_0807.docx	Supplementary Document	Uploaded 2017-08-07	Available
Att 7 Revised Eligibility and Rules for Participation clean_08072017.docx	Supplementary Document	Uploaded 2017-08-07	Available
Attachment 8. IRB determination.pdf	Supplementary Document	Uploaded 2016-09-19	Available
Attachment 4c Cross walk of change to Data Verification Form 0920-0926.docx	Supplementary Document	Uploaded 2016-09-19	Available
Attachment 4a Verification Form_ 2013 Challenge 0920-0976.docm	Supplementary Document	Uploaded 2016-09-19	Available
Attachment 3c Cross walk of changes to Nomination Form 0920-0976.docx	Supplementary Document	Uploaded 2016-09-19	Available
Attachment 3a Nomination Form 2015 Challenge 0920-0976.docm	Supplementary Document	Uploaded 2016-09-19	Available
Attachment 2a. Summary of Public Comments 0920-0976.docx	Supplementary Document	Uploaded 2016-09-19	Available
Attachment 2. 60-day FRN 5 05 2016 0920-0976.pdf	Supplementary Document	Uploaded 2016-09-19	Available
Attachment 1c. Office of Management and Budget Guidance on the Use of Challenges 0920-0976.pdf	Supplementary Document	Uploaded 2016-09-19	Available
Attachment 1b. Authorizing Legislation COMPETES.docx	Supplementary Document	Uploaded 2016-09-19	Available
Attachment 1a. Authorizing Legislation PHSA.docx	Supplementary Document	Uploaded 2016-09-19	Available
0920-0976 MH SS B_9 12 16.docx	Supporting Statement B	Uploaded 2016-09-19	Available
0920-0976 MH SS A_9 12 2016.docx	Supporting Statement A	Uploaded 2016-09-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206922	Interview Guide	Form and Instruction	Unchanged
206921	Data Verification Form	Form and Instruction	Modified
206920	Application Form	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0976	ICR Reference No: 201708-0920-007
Status: Historical Active	Previous ICR Reference No: 201609-0920-007
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-17AYF
Title: Million Hearts Hypertension Control Challenge
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: 08/08/2017
	Date Received in OIRA: 08/07/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2019	12/31/2019	12/31/2019
Responses	580	0	580
Time Burden (Hours)	370	0	370
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Disease Control and Prevention (CDC) is offering a Challenge to identify and recognize clinical care providers, including healthcare systems, that have resulted in exemplary levels of blood pressure control in their patient populations. Based on technical assistance provided by CDC in response to applications submitted for the 2017 Challenge, minor changes are proposed to the Nomination (Application) Form and the Data Verification Form. A crosswalk of Form changes is provided for reference. No changes are proposed to the Interview Form and there is no change to the estimated burden.

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Authorizing Statute(s): PL: Pub.L. 111 - 358 24 Name of Law: America COMPETES Reauthorization Act of 2010
   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:
	81 FR 27136	05/05/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 64156	09/19/2016
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
Application Form	n/a	Application Form
Data Verification Form	n/a	Revised Data Verification Form_08072017
Interview Guide	Attachment 5	Interview Guide

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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	580	580	0	0	0	0
Annual Time Burden (Hours)	370	370	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:

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Annual Cost to Federal Government: $235,700

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: 08/07/2017

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