National Center for Chronic Disease Prevention and Health Promotion: Work Plans, Progress Monitoring, and Evaluation Reporting

Forms and Documents

Document Name	Status
Form 0920-24BG Other Reporting Forms Form	New
Form 0920-24BG Evaluation Report Form	New
Form 0920-24BG Work Plan Form	New
Form 0920-24BG Evaluation Plan Form	New
privacy-narrative-form Generic ICR for Progress Monitoring 10 6 2023.pdf Supplementary Document	2024-06-28
draft cover sheet RK 2023_11 16.docx Supplementary Document	2024-06-10
30_Day_FRN Generic ICR progress monitoring.docx Supplementary Document	2024-06-10
SSA new Generic revised 6 12 2024 clean.docx Supporting Statement A	2024-06-28

IC Document Collections

IC ID	Document Title	Status
268412	Other Reporting Forms Form	New
268409	Evaluation Report Form	New
268407	Work Plan Form	New
268406	Evaluation Plan Form	New

ICR Details

OMB Control No:	ICR Reference No: 202406-0920-002
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-24BG
Title: National Center for Chronic Disease Prevention and Health Promotion: Work Plans, Progress Monitoring, and Evaluation Reporting
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/28/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	2,180	0
Time Burden (Hours)	21,380	0
Cost Burden (Dollars)	0	0

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Abstract: The purpose of this generic ICR is to allow the creation of individualized templates or forms for each phase of each award. It will cover all NCCDPHP programs. Elements such as awardee plan requirements for the area of emphasis in each award type, data reporting, and the terms that are used to define similar data requirements often vary greatly from one awardee to another. NCCDPHP does not have a single information collection mechanism that encompasses all collection needs for all cooperative agreements. Some individual programs within NCCDPHP have obtained OMB’s approval to collect information from awardees for program evaluation via individual ICRs, but creating separate ICRs for each evaluation is burdensome for both CDC and OMB.

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Authorizing Statute(s): US Code: 42 USC 421 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:
	88 FR 47959	12/01/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 47959	06/04/2024
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Evaluation Plan	0920-24BG	Evaluation Work Plan Template
Evaluation Report	0920-24BG	Evaluation Report
Other Reporting Forms	0920-24BG	Coversheet
Work Plan	0920-24BG	Work Plan

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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	2,180	0	0	2,180	0	0
Annual Time Burden (Hours)	21,380	0	0	21,380	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 collection seeking 3 years of approval for 21,230 annual burden hours.

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Annual Cost to Federal Government: $2,426

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:  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: 06/28/2024

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