I Can Do It, You Can Do It

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
ICDI Letter of Consent_Clean.docx	Supplementary Document	Uploaded 2018-06-12	Repair queued
Responses to Public Comments Received for I Can Do It Evaluation.docx	Supplementary Document	Uploaded 2018-01-26	Available
Federal Register, Volume 82 Issue 245 (Friday, December 22, 2017).htm	Supplementary Document	Uploaded 2018-01-26	Repair queued
60-day Federal Register, Volume 82 Issue 196 (Thursday, October 12, 2017).htm	Supplementary Document	Uploaded 2018-01-26	Available
ICDI FRN_Section B_Supporting Statement_Clean.docx	Supporting Statement B	Uploaded 2018-06-12	Available
ICDI_FRN_Section A_Supporting Statement_Clean.doc	Supporting Statement A	Uploaded 2018-06-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
231782	Site LOU	Other-form	New
229864	Mentor Feedback Survey	Other-feedback	New
229863	Mentee Post- Assessment	Other-POSTASSESSMENT	New
229862	Mentee Pre-Assessment	Other-PRE-ASSESSMENT	New
229860	End of Wave 2 Feedback Survey	Other-FEEDBACK SURVEY	New
229859	End of Wave 2 Interview	Other-INTERVIEW	New
229858	End of Wave 1 Feedback Survey	Other-FEEDBACK	New
229857	End of Wave 1 Interview	Other-INTERVIEW	New
229855	Site Annual Follow-Up Survey	Other-survey	New
229852	Site Application-Site Coordinator	Other-Application	New

ICR Details

OMB Control No: 0990-0463	ICR Reference No: 201710-0990-002
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: I Can Do It, You Can Do It
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/14/2018
	Date Received in OIRA: 01/26/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2021	36 Months From Approved
Responses	2,250	0	0
Time Burden (Hours)	640	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Approximately 56 million children and adults living in the United States have some level of disability. Despite physical activity and good nutrition being the cornerstones of evidence-based health promotion interventions for reducing the risk of co morbidities (e.g., diabetes, heart disease, stroke), many people with a disability or caregivers who have a child with a disability experience substantial difficulty accessing these programs. Inaccessible facilities, lack of transportation to and from indoor and outdoor recreation venues, absence of knowledgeable staff who understand how to include people with a disability in their programs, and a general perception among providers that people with a disability need ‘specialized’ versus integrated services, feed into a culture of isolation and separation and exposes this population to disproportionately higher rates of health disparities.

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Authorizing Statute(s): US Code: 42 USC USC 247b-4 Name of Law: Section 317 C of the Public Health Service Act
   PL: Pub.L. 106 - 310 317 C Name of Law: Public Health Service Act
   US Code: 42 USC 241 Name of Law: Section 301 of the 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:
	82 FR 47536	10/12/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 60752	12/22/2017
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
Mentor Feedback Survey
End of Wave 2 Interview
Mentee Post- Assessment
End of Wave 1 Feedback Survey
Site Annual Follow-Up Survey
Site Application-Site Coordinator
End of Wave 2 Feedback Survey
End of Wave 1 Interview
Mentee Pre-Assessment
Site LOU

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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	2,250	0	0	2,250	0	0
Annual Time Burden (Hours)	640	0	0	640	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: New Collection

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Annual Cost to Federal Government: $170,850

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: 01/26/2018

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