Research and PRA Determination Form

Print Date: 11/15/19

Title:

APPLETREE Performance Measures and ICRs

Project Id:

0900f3eb81a61974

Project Contact:

LeCoultre_Trent D (tll7)

Organization:

NCEH/ATSDR/DCHI

Status:

Project In Progress

Intended Use:

Project Determination

Estimated Start Date:

04/01/2020

Estimated Completion Date:

03/31/2023

CDC/ATSDR HRPO/IRB Protocol #:
OMB Control#:

Determinations
Determination

Justification

Completed

Entered By & Role

HSC:
Does NOT Require HRPO
Review

Not Research

11/15/19

Davis_Stephanie I. (sgd8) CIO HSC

PRA:
PRA Applies

11/15/19

Davis_Stephanie I. (sgd8) CIO OMB / PRA

ICRO:
Returned with No Decision

11/15/19

Zirger_Jeffrey (wtj5) ICRO Reviewer

Description & Funding
Description
Priority:

Standard

Date Needed:

12/06/2019

Determination Start Date:

11/15/19
APPLETREE performance measures and Information Collection forms to be submitted to OMB for approval in accordance with the

Description:

Paperwork Reduction Act.
Demonstrate, through regular reporting, the impact and effectiveness of APPLETREE recipients' work to reduce, eliminate, or

Goals/Purpose

prevent harmful chemical exposures in the environment.

Objective:

Collect information from APPLETREE recipients to inform performance measures, demonstrate impact, and report progress.

Activities or Tasks:

New Collection of Information, Data, or Biospecimens

Target Populations to be Included/Represented:

Awardee Program Managers

Tags/Keywords:

APPLETREE, Program Evaluation, Mandatory Reporting
Activity originated and designed by CDC staff, or conducted at the specific request of CDC, or CDC staff will approve study design

CDC's Role:

and data collection as a condition of any funding provided

Method Categories:

Other

Methods:

Data will be reported on various forms developed by ATSDR

Collection of Info, Data or Biospecimen:

Data will consist of programmatic activity tracking, event reporting, and process measurement.
ATSDR will compile information collected to report attainment of programmatic performance measures. Achieving programmatic

Expected Use of Findings/Results:

Will PII be captured?

Funding

goals will result in a demonstration of the return on investment, and positive impact on public health
No

Funding Type

Funding Title

Funding #

Original Budget Yr

# Years Award

CDC Cooperative Agreement

ATSDRs Partnership to Promote Local Efforts to Reduce Environmental Exposure (APPLETREE)

TS20-2001

2020

3

Institutions & Staff
Institutions
Institutions yet to be added .....

Staff
Staff
Member

SIQT Exp.
Date

Trent
Lecoultre

04/10/2020

CITI Biomedical
Exp. Date

CITI Social & Behavioral
Exp. Date

CITI Good Clinical
Practice Exp. Date

Staff
Role

Email

Phone

Organization

Program
Lead

tll7@cdc.
gov

770-4883799

DIVISION OF COMMUNITY HEALTH
INVESTIGATIONS

Data
DMP
Proposed Data Collection Start Date:

4/1/19

Proposed Data Collection End Date:

3/31/23

Proposed Public Access Level:

Public

Public Access Justification:

This data can be made available upon request. The data will be aggregated and summarized to be used in public-facing reports.
This data can be made available upon request. The data will be aggregated and summarized to be used in public-facing reports. No

How Access Will Be Provided for Data:

PII, confidential information, secure information, or intellectual property will be collected.

Plans for Archival and Long Term Preservation:

Data will be stored in ATSDR's Request Management System and in files held by the Project Officer.

Spatiality
Country

State/Province

County/Region

United States

Dataset
Dataset Title

Dataset yet to be
added...

Data Publisher
/Owner

Public Access
Level

Public Access
Justification

External Access
URL

Download
URL

Type of Data
Released

Dataset Start
Date

Dataset End
Date