Paul Coverdell National Acute Stroke Program (2015-2020) Assessment

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Partner Support Staff - Telephone Interview Protocol	Form and Instruction	New	Available
Data Analyst/Program Evaluator - Telephone Interview Protocol	Form and Instruction	New	Available
Quality Improvement Specialist - Telephone Interview Protocol	Form and Instruction	New	Available
Grantee Program Manager - Telephone Interview Protocol	Form and Instruction	New	Available
Principal Investigator - Telephone Interview Protocol	Form and Instruction	New	Repair queued
Partner Program Manager - Cost Resource and Utilization Tool	Form and Instruction	New	Repair queued
A4. RTI IRB Determination Memo.docx	Supplementary Document	Uploaded 2018-04-23	Available
A3. Partner Cost Collection Tool User Manual_1.5.2018.docx	Supplementary Document	Uploaded 2018-04-23	Available
PCNASP OMB Statement B - Revised_CDC comments - 1.5.2018.docx	Supporting Statement B	Uploaded 2018-04-23	Available
PCNASP OMB Statement A - Revised_08APR2018.docx	Supporting Statement A	Uploaded 2018-04-23	Available
B4. PCNASP Introductory e-mail for preparatory call.docx	Supplementary Document	Uploaded 2018-04-19	Available
B3. Thank You E-Mail for Partner Cost Data Collection_CDC.docx	Supplementary Document	Uploaded 2018-04-19	Available
B2. Invitation and Reminder Partner Cost Data Collection.docx	Supplementary Document	Uploaded 2018-04-19	Repair queued
B1. Introd Email for Partner Contact Information_1.5.2018.docx	Supplementary Document	Uploaded 2018-04-19	Repair queued
Coverdell_60DayFRN_2017-21751.pdf	Supplementary Document	Uploaded 2018-04-19	Available
Authorizing Legislation.pdf	Supplementary Document	Uploaded 2018-04-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
231177	Partner Support Staff - Telephone Interview Protocol	Form and Instruction	New
231176	Data Analyst/Program Evaluator - Telephone Interview Protocol	Form and Instruction	New
231175	Quality Improvement Specialist - Telephone Interview Protocol	Form and Instruction	New
231174	Grantee Program Manager - Telephone Interview Protocol	Form and Instruction	New
231173	Principal Investigator - Telephone Interview Protocol	Form and Instruction	New
231172	Partner Program Manager - Cost Resource and Utilization Tool	Form and Instruction	New

ICR Details

OMB Control No: 0920-1233	ICR Reference No: 201804-0920-010
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-17BAW
Title: Paul Coverdell National Acute Stroke Program (2015-2020) Assessment
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 without change	Conclusion Date: 05/22/2018
	Date Received in OIRA: 04/25/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2021	36 Months From Approved
Responses	155	0	0
Time Burden (Hours)	292	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this data collection is to collect information from all nine funded Paul Coverdell National Acute Stroke Program (PCNASP) grantees and a sample of their partners to (1) assess the actual partner costs of establishing statewide comprehensive stroke systems of care; and (2) increase CDC’s understanding of funded programs’ implementation of effective state-based stroke systems of care and PCNASP specific contributions. The timing of the data collection request aligns with the term of the funding announcement. Information obtained from this data collection will be critical to improving immediate efforts and achieving the goals of spreading and replicating state-level strategies that are proven programmatically and are cost-effective in contributing to a higher quality of care for stroke patients.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: U.S. PHSA
  

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 46993	10/10/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 17414	04/19/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Partner Program Manager - Cost Resource and Utilization Tool	NA	Cost Resource and Utilization Tool
Quality Improvement Specialist - Telephone Interview Protocol	NA	Quality Improvement Specialist - Telephone Interview Protocol
Principal Investigator - Telephone Interview Protocol	NA	Principal Investigator - Telephone Interview Protocol
Grantee Program Manager - Telephone Interview Protocol	NA	Grantee Program Manager - Telephone Interview Protocol
Data Analyst/Program Evaluator - Telephone Interview Protocol	NA	Data Analyst/Program Evaluator - Telephone Interview Protocol
Partner Support Staff - Telephone Interview Protocol	NA	Partner Support Staff - Telephone Interview Protocol

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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	155	0	0	155	0	0
Annual Time Burden (Hours)	292	0	0	292	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: Submission of 0920-17BAW is a request for a New Information Collection.

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Annual Cost to Federal Government: $97,905

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: 04/25/2018

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