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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-19DO Email Invite Fluoride Testing data	Form and Instruction	New	Repair queued
Form 0920-19DO Instructions to Update the Fluoridation Status and Population Data	Form and Instruction	New	Repair queued
Privacy Checklist_Water Fluoridation_10182018.doc	Supplementary Document	Uploaded 2020-01-07	Repair queued
19DO SSB Final.docx	Supporting Statement B	Uploaded 2020-01-07	Repair queued
19DO SSA Final.docx	Supporting Statement A	Uploaded 2020-01-07	Available
19DO Att. 3b 60-day Comments Final.docx	Supplementary Document	Uploaded 2020-01-07	Repair queued
19DO Att. 2d Respondent Reminders Final.docx	Supplementary Document	Uploaded 2020-01-07	Repair queued
19DO Att. 2c Email Invite Fluoride Testing Final.docx	Supplementary Document	Uploaded 2020-01-07	Available
19DO Att. 2b Email Invite Fluoride Status Final.docx	Supplementary Document	Uploaded 2020-01-07	Repair queued
19DO Att. 2a Fluoridation Status Instructions Final.docx	Supplementary Document	Uploaded 2020-01-07	Available
19DO Att. 4 IRB Exemption Final.pdf	Supplementary Document	Uploaded 2020-01-07	Repair queued
WFRS 399_PIA Final.pdf	Supplementary Document	Uploaded 2020-01-07	Repair queued
19DO PN Final.pdf	Supplementary Document	Uploaded 2020-01-07	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
239186	Email Invite Fluoride Testing data	Form and Instruction	New
239185	Instructions to Update the Fluoridation Status and Population Data	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202001-0920-003
Status: Received in OIRA	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: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 01/10/2020

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	83	0
Time Burden (Hours)	2,783	0
Cost Burden (Dollars)	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: Public Health Service Act
   US Code: 14 USC 247b Name of Law: ral 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	12/06/2018
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

table that charts list of burden

IC Title	Form No.	Form Name
Instructions to Update the Fluoridation Status and Population Data	0920-19DO	Instructions to Update the Fluoridation Status and Population Data
Email Invite Fluoride Testing data	0920-19DO	Email Invitation for fluoride testing data submission

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	83	0	0	83	0	0
Annual Time Burden (Hours)	2,783	0	0	2,783	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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: The purpose of this data collection is to assess the fluoridation status of the nation’s approximately 52,000 community water systems (CWS) which serve the 50 states and the District of Columbia. It will also collect fluoride level testing data for those CWS which adjust naturally occurring fluoride levels. Data will be used to inform the public and to support state and local governments’ efforts to monitor community water fluoridation levels relative to the US Public Health Service recommended level. Data will be gathered through a Web-based data management tool called the Water Fluoridation Reporting System. CDC is requesting approval for 2873 burden hours.

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Annual Cost to Federal Government: $528,578

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? No

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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: 01/10/2020

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