Poison Help General Population Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Poison Help General Population Survey	Form	Modified	Available
Appendix F - Frequently Asked Questions.docx	Supplementary Document	Uploaded 2017-09-15	Available
Appendix E - KRC Research Privacy Notice.docx	Supplementary Document	Uploaded 2017-09-15	Available
60-day FRN Poison Help 0343 Reinstatement.pdf	Supplementary Document	Uploaded 2017-09-15	Available
Supporting Statement B.docx	Supporting Statement B	Uploaded 2017-09-15	Available
Supporting Statement A.docx	Supporting Statement A	Uploaded 2017-09-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
198611	Poison Help General Population Survey	Form	Modified

ICR Details

OMB Control No: 0915-0343	ICR Reference No: 201709-0915-001
Status: Historical Active	Previous ICR Reference No: 201107-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Poison Help General Population 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: 10/19/2017
	Date Received in OIRA: 09/18/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	36 Months From Approved
Responses	4,600	0	0
Time Burden (Hours)	374	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Poison Help campaign is the vehicle for introducing the national toll-free telephone number for use in poisoning emergencies and providing poison prevention information. The goal of the Poison Help General Population Survey is to measure the campaign’s current performance. The audience for the campaign is very broad—any person at any time is a potential user of poison center services. A nationally representative tracking survey, required by law for campaign evaluation and reporting, is conducted approximately every 5 years among 2,000 U.S. adult households. The next survey will be conducted by Fall 2017.

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Authorizing Statute(s): PL: Pub.L. 110 - 377 3770-2932 Name of Law: Poison Cetner Support, Enhancement, and Awareness Act of 2008
  

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 31611	07/07/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 43391	09/15/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Poison Help General Population Survey	2, 1	Appendix B - General Population Survey.docx ,   Appendix C - General Population Survey Screener.docx

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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	4,600	0	0	4,600	0	0
Annual Time Burden (Hours)	374	0	0	374	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: In the 2017 survey instrument, questions deemed unnecessary (because information can be gleaned from other questions) were removed, and included questions related to the new additional campaign priorities (opioid, that is, prescription pain medication and heroin, overdose). In light of the current need to use of dual-frame landline and mobile phone, sampling methodologies to maintain high quality nationally representative survey sampling, standard questions related to landline vs. cell phone utilization were added for weighting and quality control purposes. Between the previously approved and conducted study in 2011 and this current initiative, there is a minimal increase in burden, from 370 to 374.

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Annual Cost to Federal Government: $109,200

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: 09/18/2017

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