APPLETREE Performance Measures

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
ATSDR Recommendation Follow-up	Form and Instruction	New	Available
ATSDR SoilSHOPS Form	Form and Instruction	New	Available
CSPECE Quantitative Form	Form and Instruction	New	Available
CSPECE Qualitative Narrative Form	Form and Instruction	New	Available
ATSDR Success Story Form	Form and Instruction	Modified	Available
APPLETREE Annual Progress Report (APR)	Form and Instruction	Modified	Available
ATSDR Site Impact Assessment Form	Form and Instruction	Modified	Available
ATSDR Technical Assistance (TA) Activity Form	Form and Instruction	Modified	Available
ATSDR Health Education Activity Tracking (HEAT) Form	Form and Instruction	Modified	Available
Att6 APPLETREE Research & PRA Determination.pdf	Supplementary Document	Uploaded 2020-04-17	Available
Att5 APPLETREE PIA CPO signed.pdf	Supplementary Document	Uploaded 2020-04-17	Available
Att3 APPLETREE NOFO CDC-RFA-TS20-2001.pdf	Supplementary Document	Uploaded 2020-04-17	Available
Att2 60-day FRN APPLETREE Revision.pdf	Supplementary Document	Uploaded 2020-04-17	Available
Att1 Authorizing Legislation CERCLA.pdf	Supplementary Document	Uploaded 2020-04-17	Available
SSB APPLETREE PMs 20200408.docx	Supporting Statement B	Uploaded 2020-04-17	Available
SSA APPLETREE PMs 20200408.docx	Supporting Statement A	Uploaded 2020-04-17	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
241391	ATSDR Recommendation Follow-up	Form and Instruction	New
241388	ATSDR SoilSHOPS Form	Form and Instruction	New
241385	CSPECE Quantitative Form	Form and Instruction	New
241384	CSPECE Qualitative Narrative Form	Form and Instruction	New
226338	ATSDR Success Story Form	Form and Instruction	Modified
226337	APPLETREE Annual Progress Report (APR)	Form and Instruction	Modified
226336	ATSDR Site Impact Assessment Form	Form and Instruction	Modified
226335	ATSDR Technical Assistance (TA) Activity Form	Form and Instruction	Modified
226334	ATSDR Health Education Activity Tracking (HEAT) Form	Form and Instruction	Modified

ICR Details

OMB Control No: 0923-0057	ICR Reference No: 202004-0923-001
Status: Historical Active	Previous ICR Reference No: 201704-0923-001
Agency/Subagency: HHS/TSDR	Agency Tracking No: 0923-17IV
Title: APPLETREE Performance Measures
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/28/2020
	Date Received in OIRA: 04/17/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2023	36 Months From Approved	09/30/2020
Responses	1,886	0	1,575
Time Burden (Hours)	267	0	272
Cost Burden (Dollars)	9,947	0	0

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Abstract: Under the APPLETREE cooperative agreement (CDC-RFA-TS17-1701), ATSDR collects information related to Awardee activities and the process and outcome performance measures. Information will be used to monitor progress toward program goals and objectives, and for quality improvement.

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Authorizing Statute(s): PL: Pub.L. 107 - 377 104(i)(15) Name of Law: Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA)
  

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 70547	12/23/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 21438	04/17/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 9

table that charts list of burden

IC Title	Form No.	Form Name
ATSDR Recommendation Follow-up	n/a	ATSDR Recommendation Follow-up Form
ATSDR SoilSHOPS Form	n/a	ATSDR SoilSHOP Form
CSPECE Qualitative Narrative Form	n/a	CSPECE Qualitative Narrative Reporting Supplement
CSPECE Quantitative Form	n/a	CSPECE Quantitative Form
ATSDR Technical Assistance (TA) Activity Form	n/a	Technical Assist Details
ATSDR Health Education Activity Tracking (HEAT) Form	n/a	Health Education (screenshots)
ATSDR Site Impact Assessment Form	n/a	Site Impact Assessment Form
APPLETREE Annual Progress Report (APR)	n/a	APPLETREE Annual Performance Report (APR)
ATSDR Success Story Form	n/a	Success Story Form

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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	1,886	1,575	0	311	0	0
Annual Time Burden (Hours)	267	272	0	-5	0	0
Annual Cost Burden (Dollars)	9,947	0	0	9,947	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There is a net reduction in the total estimated burden hours. Four short forms were added. Burden estimates for existing forms were revised downward based on experience and deletion of superfluous or redundant questions.

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Annual Cost to Federal Government: $11,028,595

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: 04/17/2020

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