Traumatic Brain Injury Disparities in Rural Areas (TBIDRA)

Forms and Documents

Document Name	Status
Form 0920-18AFX Focus Group Questionnaire Form and Instruction	New
Form 0920-18AFX Focus Group Discussion Guide Form and Instruction	New
Form 0920-18AFX Focus Group Consent Form and Instruction	New
Form 0920-18AFX Focus Group Screener Form and Instruction	New
Attachment 04_Focus Group Invitation Email.docx Supplementary Document	2019-04-01
Attachment 01_ PHSA Authorizing Legislation.doc Supplementary Document	2019-04-01
Attachment 10_IRB Exemption.docx.pdf Supplementary Document	2019-04-01
Attachment 09_ PIA_ TBIDRA-PIA-08-14-2018-Signed.pdf Supplementary Document	2019-04-01
Attachment 13_Web Survey Question Categorization.docx Supplementary Document	2018-11-05
Attachment 11_Web survey reminder email.docx Supplementary Document	2018-11-05
Attachment 10_Web Survey Invitation Email.docx Supplementary Document	2018-11-05
Attachment 9_Focus Group Question Categorization.docx Supplementary Document	2018-11-05
Attachment 06_Focus Group Consent Form.docx Supplementary Document	2018-11-05
Attachment 02_FRN_TBI Rural Areas.pdf Supplementary Document	2019-04-01
SSB_18AFX_TBIDRA_Passback - CLEAN.docx Supporting Statement B	2019-04-01
SSA_18AFX_TBIDRA_Passback - FINAL CLEAN.docx Supporting Statement A	2019-04-01

IC Document Collections

IC ID	Document Title	Status
235537	Focus Group Questionnaire Form and Instruction	New
233901	Focus Group Discussion Guide Form and Instruction	New
233899	Focus Group Consent Form and Instruction	New
233898	Focus Group Screener Form and Instruction	New

ICR Details

OMB Control No: 0920-1256	ICR Reference No: 201810-0920-010
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-18AFX
Title: Traumatic Brain Injury Disparities in Rural Areas (TBIDRA)
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: 04/02/2019
	Date Received in OIRA: 11/28/2018
Terms of Clearance: Approval is granted to conduct focus groups. If CDC determines that the focus group results support additional data collection, CDC should engage OMB in a discussion early in the development process in order to determine whether additional public notice is needed.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2021	24 Months From Approved
Responses	124	0	0
Time Burden (Hours)	48	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The study, “Traumatic Brain Injury Disparities in Rural Areas (TBIDRA)” will help CDC to better understand the challenges that rural healthcare providers face in diagnosing, treating, and managing mild TBIs - the most common type of TBI - and identify areas for future research that will allow us to better understand these challenges and potential ways to address them.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: 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:
	83 FR 26464	06/07/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 58571	11/20/2018
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Focus Group Screener	0920-18AFX	Focus Group Screener
Focus Group Consent	0920-18AFX	Focus Group Consent
Focus Group Discussion Guide	0920-18AFX	Focus Group Discussion Guide
Focus Group Questionnaire	0920-18AFX	Focus Group Questionnaire

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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	124	0	0	124	0	0
Annual Time Burden (Hours)	48	0	0	48	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: This is a New ICR

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Annual Cost to Federal Government: $26,336

Does this IC contain surveys, censuses, or employ statistical methods? No

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.     Yes

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: 11/28/2018

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