National Network of Sexually Transmitted Disease Clinical Prevention Traning Centers (NNPTC)

Forms and Documents

Document Name	Status
Intensive Long-Term Evaluation Form and Instruction	New
Intensive Post-Course Evaluation Form and Instruction	New
Standard Long-Term Evaluation Form and Instruction	New
Standard Post-Course Evaluation Form and Instruction	New
Form 0920-0995 Basic Post Course Evaluation Form and Instruction	Removed
Form 0920-0995 Basic Long-Term Evaluation Form and Instruction	Removed
Form 0920-0995 Short Guidelines Long-Term Evaluation Form and Instruction	Removed
Form 0920-0995 Short Guidelines Post-Course Evaluation Form and Instruction	Removed
Form 0920-0995 STD Treatment Guidelines Complete Long-Term Evaluation Form and Instruction	Removed
Form 0920-0995 STD Treatment Guidelines Complete Post -Course Evaluation Form and Instruction	Removed
Form 0920-0995 Wet Mount Long-Term Evaluation Form and Instruction	Removed
Form 0920-0995 Wet Mount Post-Course Evaluation Form and Instruction	Removed
Form 0920-0995 Practicum Long-Term Evaluation Form and Instruction	Removed
Form 0920-0995 Practicum Post-Course Evaluation Form and Instruction	Removed
Form 0920-0995 Intensive-Didactic Long-Term Evaluation Form and Instruction	Removed
Form 0920-0995 Intensive-Didactic Post Course Evaluation Form and Instruction	Removed
Form 0920-0995 Intensive Complete Long-Term Evaluation Form and Instruction	Removed
Form 0920-0995 Intensive Complete Post-Couse Evaluation Form and Instruction	Removed
NNPTC Abbreviated Health Professional Applicaton for Traiing (HPAT) Form and Instruction	Modified
0920-0995 Change Request_02222022.docx Justification for No Material/Nonsubstantive Change	2022-02-22
SupSta A final.docx Supporting Statement A	2020-04-03
Performance Measures STD Prevention OMB PRA Privacy Act Checklist Template 0920-0995.docx Supplementary Document	2020-03-30
CDC_PRA_Determination_Form 0920 0995.pdf Supplementary Document	2020-03-30
Att 39 Evaluation questions by instrument.xlsx Supplementary Document	2020-03-30
Att 38 Table with Description of Attachments.docx Supplementary Document	2020-03-30
Att 37 Project Determination.pdf Supplementary Document	2020-03-30
Att 3c Table of revisions to HPAT wordversion + cover sheet.docx Supplementary Document	2020-03-30
Att 2 60 Day FRN Published 110419.pdf Supplementary Document	2020-03-30
Att 1 Authorizing Legislation Section 301 PHSA.docx Supplementary Document	2020-03-30
SupSta B 0920-0995.docx Supporting Statement B	2020-03-30

IC Document Collections

IC ID	Document Title	Status
251729	Intensive Long-Term Evaluation Form and Instruction	New
251728	Intensive Post-Course Evaluation Form and Instruction	New
251727	Standard Long-Term Evaluation Form and Instruction	New
251726	Standard Post-Course Evaluation Form and Instruction	New
241012	Basic Post Course Evaluation Form and Instruction	Removed
225770	3 Month Long-Term Email Invitation Instruction	Unchanged
225769	Immediate Post-Course Email Invitation Instruction	Unchanged
225768	Basic Long-Term Evaluation Form and Instruction	Removed
225767	Short Guidelines Long-Term Evaluation Form and Instruction	Removed
225766	Short Guidelines Post-Course Evaluation Form and Instruction	Removed
225765	STD Treatment Guidelines Complete Long-Term Evaluation Form and Instruction	Removed
225764	STD Treatment Guidelines Complete Post -Course Evaluation Form and Instruction	Removed
225763	Wet Mount Long-Term Evaluation Form and Instruction	Removed
225762	Wet Mount Post-Course Evaluation Form and Instruction	Removed
225748	Practicum Long-Term Evaluation Form and Instruction	Removed
225747	Practicum Post-Course Evaluation Form and Instruction	Removed
225745	Intensive-Didactic Long-Term Evaluation Form and Instruction	Removed
225742	Intensive-Didactic Post Course Evaluation Form and Instruction	Removed
225741	Intensive Complete Long-Term Evaluation Form and Instruction	Removed
225738	Intensive Complete Post-Couse Evaluation Form and Instruction	Removed
208451	NNPTC Abbreviated Health Professional Applicaton for Traiing (HPAT) Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0995	ICR Reference No: 202202-0920-013
Status: Received in OIRA	Previous ICR Reference No: 202003-0920-018
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0995
Title: National Network of Sexually Transmitted Disease Clinical Prevention Traning Centers (NNPTC)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 02/23/2022

	Requested	Previously Approved
Expiration Date	06/30/2023	06/30/2023
Responses	11,680	11,769
Time Burden (Hours)	453	502
Cost Burden (Dollars)	0	0

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Abstract: The purpose of this data collection is to support program management of the National Network of Sexually Transmitted Disease Clinical Prevention Training Center (NNPTC) and to evaluate the reach and impact of the NNPTC's training activities. The purpose of this Change Request (submitted February 2022) is to consolidate forms across activities. This consolidation will support a unified evaluation plan.

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Authorizing Statute(s): PL: Pub.L. 42 - 792 776 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 59381	11/04/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 18982	04/03/2020
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
3 Month Long-Term Email Invitation
Basic Long-Term Evaluation	0920-0995, 0920-0995	Basic Long Term Evaluation ,   Basic Long Term Evaluation screenshot
Basic Post Course Evaluation	0920-0995, 0920-0995	Basic Post Course Evaluation ,   Basic Post Course Evaluation screenshot
Immediate Post-Course Email Invitation
Intensive Complete Long-Term Evaluation	0920-0995, 0920-0995	Intensive Complete Long-Term Evaluation wordversion ,   Intensive Complete Long-Term Evaluation -Screenshot
Intensive Complete Post-Couse Evaluation	0920-0995, 0920-0995	Intensive Complete Post-Course Evaluation wordversion ,   Intensive Complete Post-Course Evaluation -Screenshot
Intensive Long-Term Evaluation	None	Intensive Long-Term Evaluation
Intensive Post-Course Evaluation	None	Intensive Post-Course Evaluation
Intensive-Didactic Long-Term Evaluation	0920-0995, 0920-0995	Intensive Didactic Long-Term Evaluation wordversion ,   Intensive Didactic Long-Term Evaluation -Screenshot
Intensive-Didactic Post Course Evaluation	0920-0995, 0920-0995	Intensive Didactic Post-Course Evaluation wordversion ,   Intensive Didactic Post-Course Evaluation – Screenshot
NNPTC Abbreviated Health Professional Applicaton for Traiing (HPAT)	None	NNPTC Abbreviated Health Professional Application for Training
Practicum Long-Term Evaluation	0920-0995, 0920-0995	Practicum Long-Term Evaluation wordversion ,   Practicum 3-month Long-Term Evaluation -Screenshot
Practicum Post-Course Evaluation	0920-0995, 0920-0995	Practicum Post-Course Evaluation wordversion ,   Practicum Post-Course Evaluation -Screenshot
STD Treatment Guidelines Complete Long-Term Evaluation	0920-0995, 0920-0995	STD Tx Guidelines Complete Long-Term Evaluation ,   STD Tx Guidelines Complete Long-Term Evaluation screenshot
STD Treatment Guidelines Complete Post -Course Evaluation	0920-0995, 0920-0995	STD Tx Guidelines Complete Post-course Evaluation ,   STD Tx Guidelines Complete Post-Course Evaluation screenshot
Short Guidelines Long-Term Evaluation	0920-0995, 0920-0995	STD Tx Guidelines Short Long-Term Evaluation wordversion ,   STD Tx Guidelines Short Long-Term Evaluation -Screenshot
Short Guidelines Post-Course Evaluation	0920-0995, 0920-0995	STD Tx Guidelines Short Post-Course Evaluation wordversion ,   STD Tx Guidelines Short Post-Course Evaluation -Screenshot
Standard Long-Term Evaluation	None	Standard Long-Term Evaluation
Standard Post-Course Evaluation	None	Standard Post-Course Evaluation
Wet Mount Long-Term Evaluation	0920-0995, 0920-0995	Wet Mount Long-Term wordversion ,   Wet Mount Long Term Evaluation -Screenshot
Wet Mount Post-Course Evaluation	0920-0995, 0920-0995	Wet Mount Post-Course Evaluation wordversion ,   Wet Mount Post-Course Evaluation -Screenshot

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ICR Summary of Burden

	Total Request	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	11,680	11,769	0	-89	0	0
Annual Time Burden (Hours)	453	502	0	-49	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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: Changing Forms

Short Statement: The purpose of this Change Request (submitted February 2022) is to consolidate forms across activities. This consolidation will support a unified evaluation plan, by type of evaluation. In the majority of instances, burden per response will be reduced.

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Annual Cost to Federal Government: $102,783

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.     Yes

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: 02/23/2022

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