Poison Center Collaborations for Public Health Emergencies

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
1 - SSB PCCPHE Extension 20200108.docx	Supporting Statement B	Uploaded 2020-02-18	Available
1 - SSA PCCPHE Extension 20200108.docx	Supporting Statement A	Uploaded 2020-02-18	Available
Att15 Privacy Impact Assessment PCCPHE 20200108.pdf	Supplementary Document	Uploaded 2020-02-18	Available
Att14 Example Dataset for Questionnaire.xlsx	Supplementary Document	Uploaded 2020-02-18	Available
Att13 NCEH Research and PRA Determination PCCPHE 20200108.pdf	Supplementary Document	Uploaded 2020-02-18	Available
Att12 Burden Memo PCCPHE 20200108.docx	Supplementary Document	Uploaded 2020-02-18	Available
Att11 Sample Questionnaire Parent 20200108.docx	Supplementary Document	Uploaded 2020-02-18	Available
Att10 Sample Questionnaire Adolescent 20200108.docx	Supplementary Document	Uploaded 2020-02-18	Available
Att9 Sample Questionnaire Adult 20200108.docx	Supplementary Document	Uploaded 2020-02-18	Available
Att8 Sample Consent and Assent Forms.docx	Supplementary Document	Uploaded 2020-02-18	Available
Att7 GenIC Rqst Apprvl Form PCCPHE 20200108.docx	Supplementary Document	Uploaded 2020-02-18	Available
Att6 Advanced Notification Email for OMB.docx	Supplementary Document	Uploaded 2020-02-18	Available
Att5 Step-by-Step How to Use the Generic Clearance.docx	Supplementary Document	Uploaded 2020-02-18	Available
Att4 CDC-AAPCCDataLicAgremt__2016_signed.pdf	Supplementary Document	Uploaded 2020-02-18	Available
Att3 Map of United States Poison Centers.pdf	Supplementary Document	Uploaded 2020-02-18	Available
Att2 60 day Federal Register Notice.pdf	Supplementary Document	Uploaded 2020-02-18	Available
Att1 Authorizing Legislation.pdf	Supplementary Document	Uploaded 2020-02-18	Available
0920-1166 Change Request Justification FY2020 Q1.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-01-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form

ICR Details

OMB Control No: 0920-1166	ICR Reference No: 202002-0920-001
Status: Active	Previous ICR Reference No: 202001-0920-012
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1166
Title: Poison Center Collaborations for Public Health Emergencies
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: 04/30/2020
	Date Received in OIRA: 02/19/2020
Terms of Clearance: Previous terms continue: Approved consistent with the understanding that GenICs under this generic will be limited to follow-up activities in response to acute public health emergencies that may be causing adverse health outcomes. Data collection for investigations conducted under this generic will not exceed 60 days. Investigations conducted for the primary purpose of program evaluation, surveillance, needs assessment, or research (e.g., to contribute to generalizable knowledge) are excluded from this generic pathway. All GenICs submitted under this generic will include all information collection instruments and an abbreviated Supporting Statement Part A.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2023	36 Months From Approved	04/30/2020
Responses	900	0	900
Time Burden (Hours)	600	0	600
Cost Burden (Dollars)	13,924	0	12,696

---

Abstract: The goal of this generic collection is to create a timely mechanism to allow poison centers, supported by CDC, to obtain critical exposure and health information during a public health emergency. For selected events, poison center staff with CDC collaboration will conduct a call-back questionnaire to include questions not asked during initial poison center calls but are important for public health response to reduce mortality and morbidity. This request for Extension is submitted to allow CDC to continue to collect critical exposure and health information during a public health emergency through the Generic mechanism..

---

Authorizing Statute(s): US Code: 42 USC 301 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 44309	08/23/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 5665	01/31/2020
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 0

---

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	900	900	0	0	0	0
Annual Time Burden (Hours)	600	600	0	0	0	0
Annual Cost Burden (Dollars)	13,924	12,696	0	1,228	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:

---

Annual Cost to Federal Government: $123,934

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: 02/19/2020

---