Million Hearts® Hospital/Health System Recognition Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Program Application	Form	New	Available
19TG Att 8. Million Hearts Approach to Designee Vetting.docx	Supplementary Document	Uploaded 2019-08-01	Available
19TG Att 7. Eligibility for Million Hearts Program Participation.docx	Supplementary Document	Uploaded 2019-08-01	Available
19TG Att 6. IRB Determination Final.pdf	Supplementary Document	Uploaded 2019-08-01	Available
18VJ Att 5a-b Followup Materials Final.docx	Supplementary Document	Uploaded 2019-08-01	Repair queued
19TG Att 5a 60 Day FRN Final.pdf	Supplementary Document	Uploaded 2019-08-01	Available
19TG Att 4b. Confirmation Email Final.docx	Supplementary Document	Uploaded 2019-08-01	Available
19TG Att 4a. Dear Colleague Ltr Final.docx	Supplementary Document	Uploaded 2019-08-01	Available
19TG Att 3. Introduction Final.docx	Supplementary Document	Uploaded 2019-08-01	Available
19TG Att 1b. Authorizing Legislation Final.docx	Supplementary Document	Uploaded 2019-08-01	Repair queued
19TG Att 1a. Authorizing Legislation PHSA Final.docx	Supplementary Document	Uploaded 2019-08-01	Available
19TG SSB Final.docx	Supporting Statement B	Uploaded 2019-08-01	Available
19TG SSA FINAL.docx	Supporting Statement A	Uploaded 2019-08-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
237208	Interview Guide	Other-Interview Guide	New
237207	Program Application	Form	New

ICR Details

OMB Control No: 0920-1274	ICR Reference No: 201908-0920-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-19TG
Title: Million Hearts® Hospital/Health System Recognition Program
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: 11/25/2019
	Date Received in OIRA: 08/13/2019
Terms of Clearance: OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise any part of the collection, including the estimated burden, if the agency seeks to continue the information collection activity beyond the period approved under this action.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2022	36 Months From Approved
Responses	160	0	0
Time Burden (Hours)	297	0	0
Cost Burden (Dollars)	15,928	0	0

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Abstract: The Million Hearts Hospitals or Health System Recognition Program recognizes institutions working to systematically improve the cardiovascular health of the population and communities they serve. Applicants will indicate whether they will commit to implement Million Hearts® strategies; whether they are currently implementing or have previously implemented these strategies; and have achieved results in at least one strategy. Participation is voluntary.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
   PL: Pub.L. 111 - 358 1 Name of Law: America Competes Reauthorization 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:
	84 FR 12613	04/02/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 40058	08/13/2019
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Program Application	none	Million Hearts® Hospital/Health System Recognition Program Application
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	160	0	0	160	0	0
Annual Time Burden (Hours)	297	0	0	297	0	0
Annual Cost Burden (Dollars)	15,928	0	0	15,928	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: $144,835

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: 08/13/2019

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