Monitoring and Reporting for the Overdose Data to Action Cooperative Agreement

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Surveillance Data Dissemination Plan	Form and Instruction	Unchanged	Available
Surveillance Data Dissemination Plan	Form and Instruction	Unchanged	Repair queued
Activity Progress Report and Work Plan Tool	Form and Instruction	Modified	Available
Activity Progress Report and Work Plan Tool – Annual Reporting	Form and Instruction	Modified	Available
Activity Progress Report and Work Plan Tool	Form and Instruction	Unchanged	Available
Activity Progress Report and Work Plan Tool – Initial Population	Form and Instruction	Unchanged	Repair queued
Overdose Prevention Capacity Assessment Tool	Form and Instruction	Modified	Available
Organizational Capacity Assessment - Annual Reporting	Form and Instruction	Modified	Repair queued
Overdose Prevention Capacity Assessment Tool	Form and Instruction	Unchanged	Available
Organizational Capacity Assessment - Initial Population	Form and Instruction	Unchanged	Repair queued
Evaluation and Performance Measuring Plan Template	Form and Instruction	Modified	Available
Evaluation and Performance Measuring Plan Template - Annual Reporting	Form and Instruction	Modified	Repair queued
Evaluation and Performance Measuring Plan Template	Form and Instruction	Unchanged	Available
Evaluation and Performance Measuring Plan Template – Initial Population	Form and Instruction	Unchanged	Repair queued
OD2A_APR_OPCAT_Request Template Non substantial change8.25.21.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2021-09-13	Repair queued
Att 7 Crosswalk of the four required reporting.docx	Supplementary Document	Uploaded 2019-10-16	Repair queued
Att 6 Research Determination.pdf	Supplementary Document	Uploaded 2019-10-16	Repair queued
Att 5b PIA _ Overdose Data to Action.pdf	Supplementary Document	Uploaded 2019-10-16	Repair queued
Att 5a PIA_Partner's Portal.pdf	Supplementary Document	Uploaded 2019-10-16	Repair queued
Att 4 60 Dy FRN OD2A Progress Reporting.pdf	Supplementary Document	Uploaded 2019-10-16	Repair queued
Att 2 List of Funded Jurisdictions.docx	Supplementary Document	Uploaded 2019-10-16	Repair queued
Att 1 Authorizing Legislation.doc	Supplementary Document	Uploaded 2019-10-16	Repair queued
SSB_OD2A_10162019.docx	Supporting Statement B	Uploaded 2019-10-16	Available
SSA_OD2A_10162019.docx	Supporting Statement A	Uploaded 2019-10-16	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
238174	Surveillance Data Dissemination Plan	Form and Instruction	Unchanged	Surveillance Data Dissemination Plan
238174	Surveillance Data Dissemination Plan	Form and Instruction	Unchanged
238173	Activity Progress Report and Work Plan Tool – Annual Reporting	Form and Instruction	Modified	Activity Progress Report and Work Plan Tool
238173	Activity Progress Report and Work Plan Tool – Annual Reporting	Form and Instruction	Modified
238172	Activity Progress Report and Work Plan Tool – Initial Population	Form and Instruction	Unchanged	Activity Progress Report and Work Plan Tool
238172	Activity Progress Report and Work Plan Tool – Initial Population	Form and Instruction	Unchanged
238171	Organizational Capacity Assessment - Annual Reporting	Form and Instruction	Modified	Overdose Prevention Capacity Assessment Tool
238171	Organizational Capacity Assessment - Annual Reporting	Form and Instruction	Modified
238170	Organizational Capacity Assessment - Initial Population	Form and Instruction	Unchanged	Overdose Prevention Capacity Assessment Tool
238170	Organizational Capacity Assessment - Initial Population	Form and Instruction	Unchanged
238169	Evaluation and Performance Measuring Plan Template - Annual Reporting	Form and Instruction	Modified	Evaluation and Performance Measuring Plan Template
238169	Evaluation and Performance Measuring Plan Template - Annual Reporting	Form and Instruction	Modified
238168	Evaluation and Performance Measuring Plan Template – Initial Population	Form and Instruction	Unchanged	Evaluation and Performance Measuring Plan Template
238168	Evaluation and Performance Measuring Plan Template – Initial Population	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-1283	ICR Reference No: 202108-0920-016
Status: Historical Inactive	Previous ICR Reference No: 201910-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1283-21HW
Title: Monitoring and Reporting for the Overdose Data to Action Cooperative Agreement
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 12/06/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/14/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2023	01/31/2023	05/31/2023
Responses	286	0	286
Time Burden (Hours)	1,342	0	1,342
Cost Burden (Dollars)	44,740	0	44,740

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Abstract: The goal of this data collection is to gather program monitoring and reporting information from jurisdictions (which include states, Washington D.C., U.S. Territories, cities and counties) funded under the Overdose Data to Action (CDC-RFA-CE19-1904) notice of funding opportunity (OD2A NOFO). Reporting requirements have been carefully designed to align with and support the specific goals and outcomes outlined in the OD2A NOFO. The Change Request proposes edits to three of the instruments but no burden change.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

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 35865	07/25/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 59377	11/04/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
Activity Progress Report and Work Plan Tool – Annual Reporting	n/a	Activity Progress Report and Work Plan Tool
Activity Progress Report and Work Plan Tool – Initial Population	n/a	Activity Progress Report and Work Plan Tool
Evaluation and Performance Measuring Plan Template - Annual Reporting	n/a	Evaluation and Performance Measuring Plan Template
Evaluation and Performance Measuring Plan Template – Initial Population	n/a	Evaluation and Performance Measuring Plan Template
Organizational Capacity Assessment - Annual Reporting	n/a	Overdose Prevention Capacity Assessment Tool
Organizational Capacity Assessment - Initial Population	n/a	Overdose Prevention Capacity Assessment Tool
Surveillance Data Dissemination Plan	n/a	Surveillance Data Dissemination Plan

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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: This is a new information collection to support administration of the Overdose Data to Action cooperative agreement program, which went into effect October 2019.

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Annual Cost to Federal Government: $1,939,659

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: 09/14/2021

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