Monitoring and Reporting for the Overdose Data to Action Cooperative Agreement

Forms and Documents

Document Name	Status
Surveillance Data Dissemination Plan Form and Instruction	New
Activity Progress Report and Work Plan Tool – Annual Reporting Form and Instruction	New
Activity Progress Report and Work Plan Tool – Initial Population Form and Instruction	New
Organizational Capacity Assessment - Annual Reporting Form and Instruction	New
Organizational Capacity Assessment - Initial Population Form and Instruction	New
Evaluation and Performance Measuring Plan Template - Annual Reporting Form and Instruction	New
Evaluation and Performance Measuring Plan Template – Initial Population Form and Instruction	New
Att 7 Crosswalk of the four required reporting.docx Supplementary Document	2019-10-16
Att 6 Research Determination.pdf Supplementary Document	2019-10-16
Att 5b PIA _ Overdose Data to Action.pdf Supplementary Document	2019-10-16
Att 5a PIA_Partner's Portal.pdf Supplementary Document	2019-10-16
Att 4 60 Dy FRN OD2A Progress Reporting.pdf Supplementary Document	2019-10-16
Att 2 List of Funded Jurisdictions.docx Supplementary Document	2019-10-16
Att 1 Authorizing Legislation.doc Supplementary Document	2019-10-16
SSB_OD2A_10162019.docx Supporting Statement B	2019-10-16
SSA_OD2A_10162019.docx Supporting Statement A	2019-10-16

IC Document Collections

IC ID	Document Title	Status
238174	Surveillance Data Dissemination Plan Form and Instruction	New
238173	Activity Progress Report and Work Plan Tool – Annual Reporting Form and Instruction	New
238172	Activity Progress Report and Work Plan Tool – Initial Population Form and Instruction	New
238171	Organizational Capacity Assessment - Annual Reporting Form and Instruction	New
238170	Organizational Capacity Assessment - Initial Population Form and Instruction	New
238169	Evaluation and Performance Measuring Plan Template - Annual Reporting Form and Instruction	New
238168	Evaluation and Performance Measuring Plan Template – Initial Population Form and Instruction	New

ICR Details

OMB Control No: 0920-1283	ICR Reference No: 201910-0920-003
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-19BJD
Title: Monitoring and Reporting for the Overdose Data to Action Cooperative Agreement
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: 01/29/2020
	Date Received in OIRA: 11/05/2019
Terms of Clearance: OMB approves this package for three years consistent with the understanding that data collected for this purpose will not produce generalizable knowledge or allow for causal attribution. When communicating findings from this collection, all publications, both internal reports and external summaries, will clearly describe the scope and limitations of the study findings.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2023	36 Months From Approved
Responses	286	0	0
Time Burden (Hours)	1,342	0	0
Cost Burden (Dollars)	44,740	0	0

---

Abstract: The goal of this data collection is to gather program monitoring and reporting information from jurisdictions (which include states, Washington D.C., U.S. Territories, cities and counties) funded under the Overdose Data to Action (CDC-RFA-CE19-1904) notice of funding opportunity (OD2A NOFO). Reporting requirements have been carefully designed to align with and support the specific goals and outcomes outlined in the OD2A NOFO.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 35865	07/25/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 59377	11/04/2019
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 7

IC Title	Form No.	Form Name
Surveillance Data Dissemination Plan	n/a	Surveillance Data Dissemination Plan
Activity Progress Report and Work Plan Tool – Initial Population	n/a	Activity Progress Report and Work Plan Tool
Evaluation and Performance Measuring Plan Template - Annual Reporting	n/a	Evaluation and Performance Measuring Plan Template
Organizational Capacity Assessment - Annual Reporting	n/a	Overdose Prevention Capacity Assessment Tool
Activity Progress Report and Work Plan Tool – Annual Reporting	n/a	Activity Progress Report and Work Plan Tool
Organizational Capacity Assessment - Initial Population	n/a	Overdose Prevention Capacity Assessment Tool
Evaluation and Performance Measuring Plan Template – Initial Population	n/a	Evaluation and Performance Measuring Plan Template

---

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	286	0	0	286	0	0
Annual Time Burden (Hours)	1,342	0	0	1,342	0	0
Annual Cost Burden (Dollars)	44,740	0	0	44,740	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 information collection to support administration of the Overdose Data to Action cooperative agreement program, which went into effect October 2019.

---

Annual Cost to Federal Government: $1,939,659

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

---

Common Form ICR:  No

---

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: 11/05/2019

---