[NCEZID] School-Based Active Surveillance (SBAS) of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren: Phase-2 of the National Roll-Out

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-22HN School District Feedback Form	Form and Instruction	New	Repair queued
Form 0920-22HN School District Feedback Form	Form and Instruction	New	Repair queued
Form 920-22HN Webinar 1 Feedback Form	Form and Instruction	New	Available
Form 920-22HN Webinar 1 Feedback Form	Form and Instruction	New	Repair queued
Form 0920-22HN Question Guide for Face-to-Face Evaluation Interviews	Form and Instruction	New	Available
Form 0920-22HN Question Guide for Face-to-Face Evaluation Interviews	Form and Instruction	New	Repair queued
Form 0920-22HN Attachment C_SBAS_Site Baseline Survey	Form and Instruction	New	Available
Form 0920-22HN Site Baseline Survey	Form and Instruction	New	Repair queued
Form 0920-22HN Attachment B_SBAS_Demographic Data Collection Points	Form and Instruction	New	Available
Form 0920-22HN Demographic Data Collection Points	Form and Instruction	New	Repair queued
Form 0920-22HN Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form	Form and Instruction	New	Available
Form 0920-22HN Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form	Form and Instruction	New	Repair queued
2022-26886- 30DAY FRN PUBLISHED 12122022.pdf	Supplementary Document	Uploaded 2022-12-13	Repair queued
Attachment I_SBAS_Consent Form and Authorization for School District Representatives.docx	Supplementary Document	Uploaded 2022-12-01	Repair queued
Attachment J_SBAS_Consent Form and Authorization for School Nurses.docx	Supplementary Document	Uploaded 2022-12-01	Repair queued
Attachment H_SBAS_NASN IRB Exempt Determination Notice.pdf	Supplementary Document	Uploaded 2022-12-01	Repair queued
Attachment G_SBAS_Privacy Act Checklist Active Surveillance School Age Children.docx	Supplementary Document	Uploaded 2022-12-01	Repair queued
Supporting Statement B_SBAS.docx	Supporting Statement B	Uploaded 2022-12-01	Repair queued
Supporting Statement A_SBAS.docx	Supporting Statement A	Uploaded 2022-12-01	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
257211	School District Feedback Form	Form and Instruction	New	School District Feedback Form
257211	School District Feedback Form	Form and Instruction	New
257210	Webinar 1 Feedback Form	Form and Instruction	New	Webinar 1 Feedback Form
257210	Webinar 1 Feedback Form	Form and Instruction	New
257209	Question Guide for Face-to-Face Evaluation Interviews	Form and Instruction	New	Question Guide for Face-to-Face Evaluation Interviews
257209	Question Guide for Face-to-Face Evaluation Interviews	Form and Instruction	New
257208	Site Baseline Survey	Form and Instruction	New	Attachment C_SBAS_Site Baseline Survey
257208	Site Baseline Survey	Form and Instruction	New
257207	Demographic Data Collection Points	Form and Instruction	New	Attachment B_SBAS_Demographic Data Collection Points
257207	Demographic Data Collection Points	Form and Instruction	New
257206	Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form	Form and Instruction	New	Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form
257206	Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form	Form and Instruction	New

ICR Details

OMB Control No: 0920-1396	ICR Reference No: 202212-0920-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-22HN
Title: [NCEZID] School-Based Active Surveillance (SBAS) of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren: Phase-2 of the National Roll-Out
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/25/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/13/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2026	36 Months From Approved
Responses	238	0	0
Time Burden (Hours)	631	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this submission is to request OMB authorization for a new information collection, “School-Based Active Surveillance (SBAS) of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren: Phase-2 of the National Roll-Out.” We are requesting three years to complete the information/data collection. This request is to expand the previous phase (Phase-1) that was under OMB Control No. 0920-1154. The new request is for Phase-2 of the project to field test and refine data collection tools and methods for determining the frequency of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) among other currently monitored chronic health conditions associated with school absenteeism and school withdrawal among US schoolchildren (grades kindergarten through twelve, K-12). Collection of information on better-known conditions that school nurses have already been tracking, in addition to ME/CFS, will allow assessment of the quality of this surveillance approach.

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Authorizing Statute(s): None

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:
	87 FR 43864	07/22/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 76054	12/12/2022
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
Demographic Data Collection Points	0920-22HN	Attachment B_SBAS_Demographic Data Collection Points
Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form	0920-22HN	Electronic Platform Quarterly Chronic Absenteeism Data Reporting Form
Question Guide for Face-to-Face Evaluation Interviews	0920-22HN	Question Guide for Face-to-Face Evaluation Interviews
School District Feedback Form	0920-22HN	School District Feedback Form
Site Baseline Survey	0920-22HN	Attachment C_SBAS_Site Baseline Survey
Webinar 1 Feedback Form	920-22HN	Webinar 1 Feedback 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	238	0	0	238	0	0
Annual Time Burden (Hours)	631	0	0	631	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: No

Burden Reduction Due to:

Short Statement: This is a new information collection for three years of approval and 631 burden hours.

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Annual Cost to Federal Government: $348,384

Does this IC contain surveys, censuses, or employ statistical methods? No

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:  Yes

Description/Changes for Common Form Usage:  New Collection

Approved RCFs using this ICR

table that charts list of RCF

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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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: 12/13/2022

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