[NCSTLTPHIW] Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

Forms and Documents

Document Name	Status
[PHIC/NCHHSTP] 2024 TB Training and Education Needs Assessment – The U.S.-affiliated Pacific Islands – Online Survey Form and Instruction	Unchanged
[PHIC/NCHHSTP] 2024 TB Training and Education Needs Assessment – The U.S.-affiliated Pacific Islands – Online Survey Form and Instruction	Unchanged
Form 0920-0879 [PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024) Form	Unchanged
Form 0920-0879 [PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024) Form	Unchanged
Form 0920-0879 [PHIC] Assessing Funded Overdose Data to Action (OD2A) Grantee Implementation and Impacts of Stop Overdose Campaigns Form and Instruction	Unchanged
Form 0920-0879 [PHIC] Assessing Funded Overdose Data to Action (OD2A) Grantee Implementation and Impacts of Stop Overdose Campaigns Form and Instruction	Unchanged
[PHIC] CDC Funded Recipient Experience Survey Form and Instruction	Unchanged
[PHIC] CDC Funded Recipient Experience Survey Form and Instruction	Unchanged
[PHIC] OT21-2103 Success Stories (2024-2026) Form and Instruction	Unchanged
[PHIC] OT21-2103 Success Stories (2024-2026) Form and Instruction	Unchanged
Form 0920-0879 [PHIC/NCIRD] Pediatric Hepatitis-Adenovirus Case Control Evaluation, United States 2022-2026 (24CN) Form and Instruction	Unchanged
Form 0920-0879 [PHIC/NCIRD] Pediatric Hepatitis-Adenovirus Case Control Evaluation, United States 2022-2026 (24CN) Form and Instruction	Unchanged
AttG4_SurveyExtensionEmail.docx Supplementary Document	2024-10-15
AttG4_SurveyExtensionEmail.docx Supplementary Document	2024-10-15
0920-0879 MAHC Change Request_10112024.docx Justification for No Material/Nonsubstantive Change	2024-10-15
0920-0879 MAHC Change Request_10112024.docx Justification for No Material/Nonsubstantive Change	2024-10-15
Attachment B - Approved GenICs under 0920-0879.docx Supplementary Document	2023-06-20
Attachment B - Approved GenICs under 0920-0879.docx Supplementary Document	2023-06-20
Attachment C - 60 Day Federal Register Notice.pdf Supplementary Document	2023-06-20
Attachment C - 60 Day Federal Register Notice.pdf Supplementary Document	2023-06-20
Attachment A - Public Health Service Act.pdf Supplementary Document	2023-06-20
Attachment A - Public Health Service Act.pdf Supplementary Document	2023-06-20
SSB 0920_0879 extension.docx Supporting Statement B	2023-06-20
SSB 0920_0879 extension.docx Supporting Statement B	2023-06-20
SSA 0920_0879_06142023_updated.docx Supporting Statement A	2023-06-20
SSA 0920_0879_06142023_updated.docx Supporting Statement A	2023-06-20

IC Document Collections

IC ID	Document Title	Status
269900	[PHIC/NCHHSTP] 2024 TB Training and Education Needs Assessment – The U.S.-affiliated Pacific Islands – Online Survey Form and Instruction	Unchanged
269900	[PHIC/NCHHSTP] 2024 TB Training and Education Needs Assessment – The U.S.-affiliated Pacific Islands – Online Survey Form and Instruction	Unchanged
269705	[PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024) Form	Unchanged
269705	[PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024) Form	Unchanged
268184	[PHIC] Assessing Funded Overdose Data to Action (OD2A) Grantee Implementation and Impacts of Stop Overdose Campaigns Form and Instruction	Unchanged
268184	[PHIC] Assessing Funded Overdose Data to Action (OD2A) Grantee Implementation and Impacts of Stop Overdose Campaigns Form and Instruction	Unchanged
267334	[PHIC] CDC Funded Recipient Experience Survey Form and Instruction	Unchanged
267334	[PHIC] CDC Funded Recipient Experience Survey Form and Instruction	Unchanged
266981	[PHIC] OT21-2103 Success Stories (2024-2026) Form and Instruction	Unchanged
266981	[PHIC] OT21-2103 Success Stories (2024-2026) Form and Instruction	Unchanged
264737	[PHIC/NCIRD] Pediatric Hepatitis-Adenovirus Case Control Evaluation, United States 2022-2026 (24CN) Form and Instruction	Unchanged
264737	[PHIC/NCIRD] Pediatric Hepatitis-Adenovirus Case Control Evaluation, United States 2022-2026 (24CN) Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-0879	ICR Reference No: 202410-0920-015
Status: Active	Previous ICR Reference No: 202306-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0879
Title: [NCSTLTPHIW] Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/23/2024
	Date Received in OIRA: 10/16/2024
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2026	08/31/2026	08/31/2026
Responses	162,000	0	162,000
Time Burden (Hours)	162,000	0	162,000
Cost Burden (Dollars)	0	0	0

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Abstract: CDC requests an Extension to the Generic Clearance to continue to collect information related to domestic public health issues and services that affect state, tribal, local, and territorial STLT governmental entities. The Extension ICR includes a list of GENIC projects that were approved in the previous clearance period (January 2021-June 2023). Also noted [see ICR Summary of Burden, below]: There is a significant reduction in Total Cost Burden for this Extension. In the previous clearance period, CDC reported the figure calculated in SSA.12. In this Extension, per guidance from HHS, CDC is reporting the dollar amount ($0) calculated in SSA.13 This Non-Substantive Change Request is submitted to amend a previously approved GenIC (Use and Acceptability of the Model Aquatic Health Code 2024) to increase the number of focus groups from three to six and to keep the survey open for an additional two weeks..The objective, scope, and questions for the focus group will not change, and increasing the number of focus groups will not impact the overall burden approved for this generic information collection, as it would reallocate 17 burden hours from the MAHC Use and Acceptability Survey to the Focus Group.

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Authorizing Statute(s): US Code: 42 USC 301 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 3991	01/23/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 41626	06/27/2023
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
[PHIC/NCEZID] Use and Acceptability of the Model Aquatic Health Code (2024)	0920-0879, 0920-0879, 0920-0879, 0920-0879, 0920-0879	MAHC Use and Acceptability Survey (EpiInfo Web Survey) ,   Focus Group Discussion Guide—Moderate MAHC Use and Implementation ,   Focus Group Discussion Guide—Moderate MAHC Use and Implementation ,   Focus Group Discussion Guide—Advanced MAHC Use and Implementation ,   Case Study In-Depth Interview Guide
[PHIC/NCHHSTP] 2024 TB Training and Education Needs Assessment – The U.S.-affiliated Pacific Islands – Online Survey	n/a	2024 Tuberculosis (TB) Training and Education Needs Assessment of the U.S.-affiliated Pacific Islands
[PHIC/NCIRD] Pediatric Hepatitis-Adenovirus Case Control Evaluation, United States 2022-2026 (24CN)	0920-0879, 0920-0879, 0920-0879, 0920-0879, 0920-0879	PEDIATRIC HEPATITIS OF UNKNOWN ETIOLOGY MEDICAL RECORD ABSTRACTION FORM ,   Pediatric Hepatitis of Unknown Etiology - Exposures Questionnaire (Parental Interview) ,   Pediatric Hepatitis of Unknown Etiology - Exposures Questionnaire CONTROL (Parental Interview) ,   Hepatitis pediátrica de etiología desconocida - Cuestionario sobre exposiciones (entrevista a los padres) ,   Hepatitis pediátrica de etiología desconocida. CONTROL del cuestionario sobre exposiciones (Entrevista a los padres)
[PHIC] Assessing Funded Overdose Data to Action (OD2A) Grantee Implementation and Impacts of Stop Overdose Campaigns	0920-0879, 0920-0879	O2DA Partner Evaluation Survey: Screener and Annotated Questionnaire ,   O2DA Partner Evaluation Survey: Screener and Annotated Questionnaire
[PHIC] CDC Funded Recipient Experience Survey	n/a	CDC Funded Recipient Experience Survey
[PHIC] OT21-2103 Success Stories (2024-2026)	n/a	OT20-2103 Success Stories Form

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ICR Summary 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	162,000	162,000	0	0	0	0
Annual Time Burden (Hours)	162,000	162,000	0	0	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $92,950

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: 10/16/2024

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