Sealant Efficiency Assessment for Locals and States (SEALS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Add Event - SSP Local Administrator	Form and Instruction	New	Available
Program Options and Cost Options - SSP Local Administrator	Form and Instruction	New	Repair queued
Add User and Add School - SSP Local Administrator	Form and Instruction	New	Available
Add Program and Add User - State Sealant Administrator	Form and Instruction	New	Available
SEALS SSB Final.docx	Supporting Statement B	Uploaded 2019-11-18	Available
SSA_OMB_010312019.docx	Supporting Statement A	Uploaded 2019-11-18	Available
SEALS PIA Final.pdf	Supplementary Document	Uploaded 2019-11-18	Available
SEALS IRB Final.pdf	Supplementary Document	Uploaded 2019-11-18	Available
SEALS Att 2f Request to Funded & Unfunded States Final.docx	Supplementary Document	Uploaded 2019-11-18	Available
SEALS Att 2e Default Cost Values SS Final.docx	Supplementary Document	Uploaded 2019-11-18	Available
SEALS Att 2b State Comparison Rpt Final.docx	Supplementary Document	Uploaded 2019-11-18	Available
SEALS Att 2a_Sample Rpts Final.xlsx	Supplementary Document	Uploaded 2019-11-18	Available
SEALS Att 1 Legislation Final.pdf	Supplementary Document	Uploaded 2019-11-15	Available
SEALS 60 Day FRN Published.pdf	Supplementary Document	Uploaded 2019-11-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
238600	Add Event - SSP Local Administrator	Form and Instruction	New
238599	Program Options and Cost Options - SSP Local Administrator	Form and Instruction	New
238598	Add User and Add School - SSP Local Administrator	Form and Instruction	New
238597	Add Program and Add User - State Sealant Administrator	Form and Instruction	New

ICR Details

OMB Control No: 0920-1289	ICR Reference No: 201910-0920-011
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-19ACI
Title: Sealant Efficiency Assessment for Locals and States (SEALS)
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/23/2020
	Date Received in OIRA: 11/20/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2023	36 Months From Approved
Responses	1,194	0	0
Time Burden (Hours)	463	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Approval of Sealant Efficiency Assessment for Locals and States (SEALS) is requested to lower caries rates among at-risk children by increasing the efficiency of local school sealant programs, which in turn will lead to more children receiving sealants to prevent oral health disease. Data will be used to generate school sealant program (SSP) efficiency performance measures (e.g., cost per averted cavity), and state oral health programs can use this information to monitor progress and increase efficiency, document return on investment, and increase their reach. CDC will use this information to identify feasible benchmarks for SSPs and identify best practices contributing to SSP efficiency to share with states and stakeholders.

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Authorizing Statute(s): US Code: 42 USC 301 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:
	84 FR 13924	04/08/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 61908	11/14/2019
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Add User and Add School - SSP Local Administrator	NA	Add User and Add School
Add Event - SSP Local Administrator	NA	Add Event
Add Program and Add User - State Sealant Administrator	NA	Add Program and Add User
Program Options and Cost Options - SSP Local Administrator	NA	Program Options and Cost Options

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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	1,194	0	0	0	0	1,194
Annual Time Burden (Hours)	463	0	0	0	0	463
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $62,810

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.     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: 11/20/2019

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