[ATSDR] APPLETREE Performance Measures

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
ATSDR Requests for Certified PHAs/HCs	Form and Instruction	New	Available
ATSDR Requests Form	Form and Instruction	New	Available
ATSDR Recommendation Follow-up Form	Form and Instruction	Modified	Repair queued
ATSDR Recommendation Follow-up	Form and Instruction	Modified	Repair queued
ATSDR SoilSHOP Form	Form and Instruction	Modified	Available
ATSDR SoilSHOPS Form	Form and Instruction	Modified	Repair queued
CSPECE Quantitative Form	Form and Instruction	Modified	Available
CSPECE Quantitative Form	Form and Instruction	Modified	Repair queued
CSPECE Qualitative Narrative Reporting Supplement	Form and Instruction	Modified	Available
CSPECE Qualitative Narrative Form	Form and Instruction	Modified	Repair queued
Success Story Form (screenshots)	Form and Instruction	Modified	Available
ATSDR Success Story Form	Form and Instruction	Modified	Repair queued
APPLETREE Annual Performance Report (APR)	Form and Instruction	Modified	Available
APPLETREE Annual Progress Report (APR)	Form and Instruction	Modified	Repair queued
Site Impact Assessment Form	Form and Instruction	Modified	Available
ATSDR Site Impact Assessment Form	Form and Instruction	Modified	Repair queued
Technical Assist Details (screenshots)	Form and Instruction	Modified	Available
ATSDR Technical Assistance (TA) Activity Form	Form and Instruction	Modified	Repair queued
Health Education (screenshots)	Form and Instruction	Modified	Available
ATSDR Health Education Activity Tracking (HEAT) Form	Form and Instruction	Modified	Repair queued
Att6 APPLETREE 2023 Rev Research Determination.pdf	Supplementary Document	Uploaded 2023-09-18	Repair queued
Att5 APPLETREE 2023 PIA (PENDING APPROVAL WILL BE REPLACED).pdf	Supplementary Document	Uploaded 2023-09-18	Repair queued
Att3 APPLTREE NOFO No. CDC-RFA-TS-23-0001.pdf	Supplementary Document	Uploaded 2023-09-18	Repair queued
Att2 APPLETREE PMs 2023 Rev 60-day FRN.pdf	Supplementary Document	Uploaded 2023-09-18	Repair queued
Att1 APPLETREE PM 2023 Rev Authorizing Legislation CERCLA.pdf	Supplementary Document	Uploaded 2023-09-18	Repair queued
1 - SSB APPLETREE PMs 2023 Rev 20230831.docx	Supporting Statement B	Uploaded 2023-09-18	Repair queued
1 - SSA APPLETREE PMs 2023 Rev 20230831_final.docx	Supporting Statement A	Uploaded 2023-09-18	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
262208	ATSDR Requests Form	Form and Instruction	New	ATSDR Requests for Certified PHAs/HCs
262208	ATSDR Requests Form	Form and Instruction	New
241391	ATSDR Recommendation Follow-up	Form and Instruction	Modified	ATSDR Recommendation Follow-up Form
241391	ATSDR Recommendation Follow-up	Form and Instruction	Modified
241388	ATSDR SoilSHOPS Form	Form and Instruction	Modified	ATSDR SoilSHOP Form
241388	ATSDR SoilSHOPS Form	Form and Instruction	Modified
241385	CSPECE Quantitative Form	Form and Instruction	Modified	CSPECE Quantitative Form
241385	CSPECE Quantitative Form	Form and Instruction	Modified
241384	CSPECE Qualitative Narrative Form	Form and Instruction	Modified	CSPECE Qualitative Narrative Reporting Supplement
241384	CSPECE Qualitative Narrative Form	Form and Instruction	Modified
226338	ATSDR Success Story Form	Form and Instruction	Modified	Success Story Form (screenshots)
226338	ATSDR Success Story Form	Form and Instruction	Modified
226337	APPLETREE Annual Progress Report (APR)	Form and Instruction	Modified	APPLETREE Annual Performance Report (APR)
226337	APPLETREE Annual Progress Report (APR)	Form and Instruction	Modified
226337	APPLETREE Annual Progress Report (APR)	Instruction	Modified
226336	ATSDR Site Impact Assessment Form	Form and Instruction	Modified	Site Impact Assessment Form
226336	ATSDR Site Impact Assessment Form	Form and Instruction	Modified
226336	ATSDR Site Impact Assessment Form	Other-Word document to display instrument content	Modified
226335	ATSDR Technical Assistance (TA) Activity Form	Form and Instruction	Modified	Technical Assist Details (screenshots)
226335	ATSDR Technical Assistance (TA) Activity Form	Form and Instruction	Modified
226335	ATSDR Technical Assistance (TA) Activity Form	Other-WORD document to display instrument content	Modified
226334	ATSDR Health Education Activity Tracking (HEAT) Form	Form and Instruction	Modified	Health Education (screenshots)
226334	ATSDR Health Education Activity Tracking (HEAT) Form	Form and Instruction	Modified
226334	ATSDR Health Education Activity Tracking (HEAT) Form	Other-WORD document to display instrument content	Modified

ICR Details

OMB Control No: 0923-0057	ICR Reference No: 202309-0923-001
Status: Active	Previous ICR Reference No: 202009-0923-003
Agency/Subagency: HHS/TSDR	Agency Tracking No: 0923-0057
Title: [ATSDR] APPLETREE Performance Measures
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/27/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/19/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2026	36 Months From Approved	10/31/2023
Responses	1,540	0	1,886
Time Burden (Hours)	269	0	267
Cost Burden (Dollars)	0	0	9,947

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Abstract: Under the APPLETREE cooperative agreement (CDC-RFA-TS17-1701), ATSDR collects information related to Awardee activities and the process and outcome performance measures. Information will be used to monitor progress toward program goals and objectives, and for quality improvement. The revision includes a minor increase in respondents, additional forms, and other minor changes.

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Authorizing Statute(s): PL: Pub.L. 107 - 377 104(i)(15) Name of Law: Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA)
  

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:
	88 FR 41620	06/27/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 63953	09/18/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
APPLETREE Annual Progress Report (APR)	n/a	APPLETREE Annual Performance Report (APR)
ATSDR Health Education Activity Tracking (HEAT) Form	n/a	Health Education (screenshots)
ATSDR Recommendation Follow-up	n/a	ATSDR Recommendation Follow-up Form
ATSDR Requests Form	n/a	ATSDR Requests for Certified PHAs/HCs
ATSDR Site Impact Assessment Form	n/a	Site Impact Assessment Form
ATSDR SoilSHOPS Form	n/a	ATSDR SoilSHOP Form
ATSDR Success Story Form	n/a	Success Story Form (screenshots)
ATSDR Technical Assistance (TA) Activity Form	n/a	Technical Assist Details (screenshots)
CSPECE Qualitative Narrative Form	n/a	CSPECE Qualitative Narrative Reporting Supplement
CSPECE Quantitative Form	n/a	CSPECE Quantitative 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	1,540	1,886	0	-346	0	0
Annual Time Burden (Hours)	269	267	0	2	0	0
Annual Cost Burden (Dollars)	0	9,947	0	-9,947	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: Miscellaneous Actions

Short Statement: The change in burden is due to a slight increase in respondents, minor adjustments to burden times, and one additional form.

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Annual Cost to Federal Government: $14,855,506

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.     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: 09/19/2023

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