National Surveillance of Community Water Systems and Corresponding Populations with the Recommended Fluoridation Level

Forms and Documents

Document Name	Status
Form 19DOc Fluoride testing data Form and Instruction	New
Form 19DOa Fluoridation status and population Form and Instruction	New
Privacy Checklist_Water Fluoridation_10182018.doc Supplementary Document	2019-11-04
2d_Respondent Reminders.docx Supplementary Document	2019-11-04
2c_Email invitation_fluoride testing data_08222018.docx Supplementary Document	2019-11-04
4_IRB exemption determination.pdf Supplementary Document	2019-11-04
1_Legislation.pdf Supplementary Document	2019-11-04
2d_Respondent Reminders.docx Supplementary Document	2019-10-28
19DO SSB Final.docx Supporting Statement B	2019-10-21
19DO SSA Final.docx Supporting Statement A	2019-10-21

IC Document Collections

IC ID	Document Title	Status
238297	Fluoride testing data Form and Instruction	New
238295	Fluoridation status and population Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 201910-0920-006
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-19DO
Title: National Surveillance of Community Water Systems and Corresponding Populations with the Recommended Fluoridation Level
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: Improperly submitted	Conclusion Date: 01/03/2020
	Date Received in OIRA: 11/05/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC collects fluoridation level and status of Community Water Systems (CWS) and corresponding population from states to 1) report fluoridation status relative to the USPHS recommended level for oral health among 52,000 CWS and the percentage of population served by CWS with fluoridated water nationally and by locality; 2) support state and local government monitoring of community water fluoridation programs; 3) measure national performance toward the Healthy People objective.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Oral health promotion and disease prevention
  

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 62867	12/16/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 59384	11/04/2019
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Fluoride testing data	19DOc	Fluoride testing data
Fluoridation status and population	19DOa	Fluoridation status and population

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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: There is an increase in burden due to this being a new ICR.

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Annual Cost to Federal Government: $266,193

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.     Yes

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: 11/05/2019

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