CDC/ATSDR Formative Research and Tool Development

Forms and Documents

Document Name	Status
Health Education and Health Promotion in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Knowledge, Attitudes and Beliefs in the U.S. General Public Form and Instruction	New
Formative Evaluation of an Immersive VRMine Rescue Contest Simulation Exercise Form and Instruction	New
Formative Research to Support Active Surveillance of Myalgic Encelphalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren Form	New
Form 0920-20MD American Academy of Pediatrics Resident Training in Developmental Continuity Clinics (part 3) Form and Instruction	New
Form 0920-1154 American Academy of Pediatrics Neurodevelopmental (ECHO) Form and Instruction	New
Form 0920-1154 Formative Research and Tool Development - "Strengthening hospital-based youth violence prevention Form and Instruction	New
Form 0920-1154 DREXEL-CYSHCN Form and Instruction	New
Form 0920-20IU Characterization of Haul Truck Health and Safety Issues Form and Instruction	New
Form 0920-20LK Formative Assessment of the Information Needs of Adapting NIOSH-CPWR toolbox talks for Spanish-speaking construction workers: Phase 1 Form and Instruction	New
Form 0920-1154 Strengthening hospital-based youth violence prevention Form and Instruction	New
GenICRequestTemplate.docx Supplementary Document	2019-12-05
60 day FRN.pdf Supplementary Document	2019-12-05
SSB.docx Supporting Statement B	2019-12-05
SSA.2019.doc Supporting Statement A	2019-12-05
AuthLegislation.doc Supplementary Document	2016-10-20

IC Document Collections

IC ID	Document Title	Status
244720	Health Education and Health Promotion in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Knowledge, Attitudes and Beliefs in the U.S. General Public Form and Instruction	New
244188	Formative Evaluation of an Immersive VRMine Rescue Contest Simulation Exercise Form and Instruction	New
243850	Formative Research to Support Active Surveillance of Myalgic Encelphalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren Form	New
243553	(genIC) Feedback Survey for Community Counts Data Viz Tool Other-Screenshots	New
242950	American Academy of Pediatrics Resident Training in Developmental Continuity Clinics (part 3) Form and Instruction	New
242188	American Academy of Pediatrics Neurodevelopmental (ECHO) Form and Instruction	New
241652	Formative Research and Tool Development - "Strengthening hospital-based youth violence prevention Form and Instruction	New
241328	DREXEL-CYSHCN Form and Instruction	New
241323	Characterization of Haul Truck Health and Safety Issues Form and Instruction	New
241061	Formative Assessment of the Information Needs of Adapting NIOSH-CPWR toolbox talks for Spanish-speaking construction workers: Phase 1 Form and Instruction	New
239851	Strengthening hospital-based youth violence prevention Form and Instruction	New

ICR Details

OMB Control No: 0920-1154	ICR Reference No: 201912-0920-003
Status: Active	Previous ICR Reference No: 201610-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1154
Title: CDC/ATSDR Formative Research and Tool Development
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/21/2020
	Date Received in OIRA: 12/23/2019
Terms of Clearance: Previous terms continue: OMB approves this umbrella generic, and has informed CDC/ATSDR that each individual study should be submitted into ROCIS an a genIC that includes full supporting statement Part A and an accompanying Supporting Statement Part B if any statistical methods are employed for sampling or analyses of data. A complete justification for any incentives offered to respondents will also accompany all substudies submitted under this Generic. Outcomes collected under this generic pathway are intended for internal CDC/ATSDR use only and will not be generalized beyond the scope of each study or to broader populations.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2023	36 Months From Approved	01/31/2020
Responses	75,000	0	60,000
Time Burden (Hours)	60,000	0	56,250
Cost Burden (Dollars)	1,500,000	0	1,125,000

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Abstract: CDC/ATSDR requests an extension of a generic clearance to conduct formative research for developing new tools and methodologies to support agency research, surveillance, and program evaluation activities, and the development and assessment of multi-use tools.

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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:
	84 FR 44308	08/23/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 66909	12/06/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 11

IC Title	Form No.	Form Name
DREXEL-CYSHCN	0920-1154, 0920-1154, 0920-1154, 0920-1154, 0920-1154	DISASTER PREPAREDNESS HOME ASSESSMENT SCREENING TOOL -- revised ,   DISASTER PREPAREDNESS HOME ASSESSMENT SCREENING TOOL -- revised ,   DREXEL -DEMOGRAPHIC INTAKE FORM ,   DISASTER PREPAREDNESS HOME ASSESSMENT SCREENING TOOL ,   INTERVIEW GUIDE FOR BRIEF FAMILY INTERVIEW
Formative Evaluation of an Immersive VRMine Rescue Contest Simulation Exercise	n/a, n/a, n/a	Briefing Officer Survey ,   Team Trainer Interview Questions ,   Exploration Team Survey
Formative Research to Support Active Surveillance of Myalgic Encelphalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren	none, none, none, none, none	School District Feedback Form ,   Electronic Platform Chronic Absenteeism Reporting Form ,   Demographic Data Collection Points ,   Pilot Site Baseline Survey ,   Webinar Feedback Form
Characterization of Haul Truck Health and Safety Issues	0920-20IU, 0920-20IU	Cognitive Task Analysis (CTA) Interview Guide ,   Critical Decision Method (CDM) Semi-Structured Interview Guide
(genIC) Feedback Survey for Community Counts Data Viz Tool
American Academy of Pediatrics Neurodevelopmental (ECHO)	0920-1154, 0920-1154, 0920-1154, 0920-1154	Peditrician - ECHO Chart Review ,   Pediatrician - ECHO Session Satisfaction Survey ,   Pediatrician - ECHO Program Satisfaction Survey ,   Pediatrician - ECHO Debriefing Conference Call
Formative Research and Tool Development - "Strengthening hospital-based youth violence prevention	0920-1154	Interview Guide
Health Education and Health Promotion in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Knowledge, Attitudes and Beliefs in the U.S. General Public	n/a, n/a	Screener ,   Survey
Formative Assessment of the Information Needs of Adapting NIOSH-CPWR toolbox talks for Spanish-speaking construction workers: Phase 1	0920-20LK	NIOSH Toolbox Focus Group Guide
American Academy of Pediatrics Resident Training in Developmental Continuity Clinics (part 3)	0920-20MD, 0920-20MD, 0920-20MD, 0920-20MD, 0920-20MD, 0920-20MD, 0920-20MD, 0920-20MD, 0920-20MD, 0920-20MD, 0920-20MD, 0920-20MD	Attachment A1_Attending Physicians_Screening & Diagnosis pretest ,   Attachment A2_Attending Physicians_Screening & Diagnosis post test ,   Attachment A3_Attending Physicians_Treatment Across Lifespan pretest ,   Attachment A4_Attending Physicians_Treatment Across Lifespan post test ,   Attachment A5_Attending Physicians_Overcoming Social Attitudes pretest ,   Attachment A6_Attending Physicians_Overcoming Social Attitudes post test ,   Attachment A7_Attending Physicians_Educational Care pretest ,   Attachment A9_Attending Physicians_Training Program Evaluation ,   Attachment A10_Resident_Overall Effects & Prevalence video pretest ,   Attachment A11_Resident_Overall Effects & Prevalence video post test ,   Attachment A12_Resident_Overall Program Evaluation ,   Attachment A13_Attending Physician_Overall Program Evaluation
Strengthening hospital-based youth violence prevention	0920-1154	Interview Guide

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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	75,000	60,000	0	15,000	0	0
Annual Time Burden (Hours)	60,000	56,250	0	3,750	0	0
Annual Cost Burden (Dollars)	1,500,000	1,125,000	0	375,000	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 extension request includes an increase in burden due to increased use of the generic over the past 3 years.

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Annual Cost to Federal Government: $474,091

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: 12/23/2019

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