Prevention Communication Formative Research

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 NYSS Champion Program Application	Form and Instruction	New	Repair queued
Form Healthy People 203 Healthy People 2030 Champion Application	Form and Instruction	New	Repair queued
Form ODPHP/PCSFN Speaki ODPHP/PCSFN Speaking Request Form	Form and Instruction	New	Repair queued
Form 1 ODPHP Speakers Bureau Application	Form and Instruction	New	Repair queued
0990-0281 Father Genric Supporting Statement 9.17.21.docx	Supporting Statement A	Uploaded 2021-09-21	Repair queued
Section B.docx	Supporting Statement B	Uploaded 2021-09-21	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
254801	NYSS Champion Application	Form and Instruction	New	NYSS Champion Program Application
253014	Mothers at Risk for Postpartum Depression	Other-Recruitment screener	New
252506	Healthy People 2030 Champion Application	Form and Instruction	New	Healthy People 2030 Champion Application
251778	ODPHP/PCSFN Speaker Request Form	Form and Instruction	New	ODPHP/PCSFN Speaking Request Form
251778	ODPHP/PCSFN Speaker Request Form	Form and Instruction	New	ODPHP Speakers Bureau Application
251073	ODPHP Presidential Youth Fitness Program Focus Groups	Other-Teacher Recruitment Screener	New
250514	Understanding Economic Risk for Low Income Families Survey	Other-	New

ICR Details

OMB Control No: 0990-0281	ICR Reference No: 202109-0990-009
Status: Historical Active	Previous ICR Reference No: 201803-0990-002
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Prevention Communication Formative Research
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: 10/26/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/21/2021
Terms of Clearance: Approved consistent with the understanding that individual memos explaining the exact methods for information collection will be submitted for each study under this clearance as Gen ICs and data collection will not begin until approval is received for the individual Gen IC.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2024	36 Months From Approved	10/31/2021
Responses	56,975	0	56,975
Time Burden (Hours)	9,975	0	19,950
Cost Burden (Dollars)	0	0	0

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Abstract: This generic clearance request describes data collection activities involving a limited set of focus groups, individual interviews, Web-based concept and prototype testing, and usability and effects testing to establish a deeper understanding of the interests and needs of consumers and health intermediaries for disease prevention and health promotion information and tools.

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Authorizing Statute(s): PL: Pub.L. 94 - 317 201 Name of Law: National Consumer Health Information and Health Promotion Act of 1976
   US Code: 44 USC 3502(2) Name of Law: COORDINATION OF FEDERAL INFORMATION POLICY
  

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:
	86 FR 34025	06/28/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 52478	09/21/2021
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Healthy People 2030 Champion Application	Healthy People 2030 Champion Application	Healthy People 2030 Champion Application
Mothers at Risk for Postpartum Depression
NYSS Champion Application	1	NYSS Champion Program Application
ODPHP Presidential Youth Fitness Program Focus Groups
ODPHP/PCSFN Speaker Request Form	1, ODPHP/PCSFN Speaking Request Form	ODPHP Speakers Bureau Application ,   ODPHP/PCSFN Speaking Request Form
Understanding Economic Risk for Low Income Families Survey

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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	56,975	56,975	0	0	0	0
Annual Time Burden (Hours)	9,975	19,950	0	-9,975	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: ODPHP is proposing the following program changes: 1. Revise purpose and justification to reflect office initiatives and priorities for the next 3 years. 2. Increase estimated hourly rate of respondents due to cost of living increases. 3. Some data collection efforts are no longer needed. Previous submission was approved for 19950 hours, however those data collection efforts have ended therefore decreasing the total required burden hours by 9975 hours, resulting in a final total burden time of 9975.

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Annual Cost to Federal Government: $215,000

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: 09/21/2021

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