[NCIPC] Reporting of the Essentials for Childhood (EfC): Preventing Adverse Childhood Experiences through Data to Action Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920 Instrument and Protocol Surveillance Capacity Assessment (SCA)	Form and Instruction	Unchanged	Available
Form 0920 Instrument and Protocol Implementation Capacity Assessment (ICA)	Form and Instruction	Unchanged	Missing upstream
Form 0920-1425 Essentials Instrument and Protocol Evaluation and Surveillance Survey - Revised 10JUL2025	Form and Instruction	Modified	Available
Form 0920 Essentials Instrument and Protocol Evaluation and Surveillance Survey	Form and Instruction	Modified	Available
Form 0920 Essentials Instrument and Protocol Evaluation and Surveillance Survey	Form and Instruction	Modified	Repair queued
Form 0920 Instrument and Protocol Key Informant Interview - Principal Investigators	Form and Instruction	Unchanged	Available
Form 0920 Instrument and Protocol Surveillance Capacity Assessment (SCA)	Form and Instruction	Unchanged	Missing upstream
Form 0920 Instrument and Protocol Key Informant Interview - Principal Investigators	Form and Instruction	Unchanged	Available
Form 0920 Instrument and Protocol Key Informant Interview - Principal Investigators/Implementer	Form and Instruction	Unchanged	Repair queued
Form 0920 Instrument and Protocol Key Informant Interview - Principal Investigators	Form and Instruction	Unchanged	Available
Form 0920 Instrument and Protocol Key Informant Interview - Principal Investigators	Form and Instruction	Unchanged	Repair queued
Form 0920-1425 Annual Performance Report (APR) Tool - Revised 22JUL2025	Form and Instruction	Modified	Available
Form 0920- Annual Performance Report (APR) Tool	Form and Instruction	Modified	Available
Form 0920- Annual Performance Report (APR) Tool	Form and Instruction	Modified	Available
Change Request Memo - Essentials for Childhood 072125.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-07-22	Available
Change Request Memo - EO14168 Updates Essentials for Childhood.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-07-10	Repair queued
SSB_EfC_Program_9_14_23.docx	Supporting Statement B	Uploaded 2023-10-25	Available
SSB_EfC_Program_9_14_23.docx	Supporting Statement B	Uploaded 2023-10-25	Available
SSA_EfC Program_050125 EO clean.docx	Supporting Statement A	Uploaded 2025-07-10	Available
SSA_EfC Program_050125 EO clean.docx	Supporting Statement A	Uploaded 2025-07-10	Available
Att. 8 Research Determination.pdf	Supplementary Document	Uploaded 2023-10-12	Available
Att. 8 Research Determination.pdf	Supplementary Document	Uploaded 2023-10-12	Repair queued
Att. 7 EfC-ICR-PII-Privacy Act-Determination.pdf	Supplementary Document	Uploaded 2023-10-12	Available
Att. 7 EfC-ICR-PII-Privacy Act-Determination.pdf	Supplementary Document	Uploaded 2023-10-12	Missing upstream
Att. 1_PHSA_301a_USC_241a and Section 393USC 280b-1a.pdf	Supplementary Document	Uploaded 2023-10-12	Available
Att. 1_PHSA_301a_USC_241a and Section 393USC 280b-1a.pdf	Supplementary Document	Uploaded 2023-10-12	Missing upstream

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
262779	Instrument and Protocol Implementation Capacity Assessment (ICA)	Form and Instruction	Unchanged	Instrument and Protocol Surveillance Capacity Assessment (SCA)
262779	Instrument and Protocol Implementation Capacity Assessment (ICA)	Form and Instruction	Unchanged
262777	Essentials Instrument and Protocol Evaluation and Surveillance Survey	Form and Instruction	Modified	Essentials Instrument and Protocol Evaluation and Surveillance Survey - Revised 10JUL2025
262777	Essentials Instrument and Protocol Evaluation and Surveillance Survey	Form and Instruction	Modified	Essentials Instrument and Protocol Evaluation and Surveillance Survey
262777	Essentials Instrument and Protocol Evaluation and Surveillance Survey	Form and Instruction	Modified
262776	Instrument and Protocol Surveillance Capacity Assessment (SCA)	Form and Instruction	Unchanged	Instrument and Protocol Key Informant Interview - Principal Investigators
262776	Instrument and Protocol Surveillance Capacity Assessment (SCA)	Form and Instruction	Unchanged
262775	Instrument and Protocol Key Informant Interview - Principal Investigators/Implementer	Form and Instruction	Unchanged	Instrument and Protocol Key Informant Interview - Principal Investigators
262775	Instrument and Protocol Key Informant Interview - Principal Investigators/Implementer	Form and Instruction	Unchanged
262773	Instrument and Protocol Key Informant Interview - Principal Investigators	Form and Instruction	Unchanged	Instrument and Protocol Key Informant Interview - Principal Investigators
262773	Instrument and Protocol Key Informant Interview - Principal Investigators	Form and Instruction	Unchanged
262771	Annual Performance Report (APR) Tool	Form and Instruction	Modified	Annual Performance Report (APR) Tool - Revised 22JUL2025
262771	Annual Performance Report (APR) Tool	Form and Instruction	Modified	Annual Performance Report (APR) Tool
262771	Annual Performance Report (APR) Tool	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-1425	ICR Reference No: 202507-0920-007
Status: Active	Previous ICR Reference No: 202310-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1425-25-0135
Title: [NCIPC] Reporting of the Essentials for Childhood (EfC): Preventing Adverse Childhood Experiences through Data to Action Program
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 with change	Conclusion Date: 07/22/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/10/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2026	12/31/2026	12/31/2026
Responses	72	0	72
Time Burden (Hours)	168	0	168
Cost Burden (Dollars)	0	0	0

---

Abstract: The goal of this ICR is to collect data to monitor project performance from grantees funded under Essentials for Childhood (EfC): Preventing Adverse Childhood Experiences through Data to Action. Information collected from recipients will be used to monitor and evaluate progress of program goals and objectives, identify technical assistance needs, and be accountable for the funding by responding to requests for information about the cooperative agreement. The population studied will include 100% of EfC-funded recipients. Therefore, a sampling method is not required. Recipients will report performance data to CDC annually using a web-based system (i.e., Partners’ Portal). No research design or human subjects involved. Information will be also collected via virtual interview sessions. Quantitative data will be analyzed using descriptive and summary statistics. Qualitative data will be analyzed through thematic analysis to define priority area topics and emerging themes. This Non-Substantive Change Request is submitted for compliance with recently issued EOs 14168 and 14151. There is no anticipated change to the approved burden.

---

Authorizing Statute(s): US Code: 42 USC 301(a) 241a Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 19308	03/31/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 75591	11/03/2023
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Annual Performance Report (APR) Tool	0920-1425, 0920-	Annual Performance Report (APR) Tool ,   Annual Performance Report (APR) Tool - Revised 22JUL2025
Essentials Instrument and Protocol Evaluation and Surveillance Survey	0920, 0920-1425	Essentials Instrument and Protocol Evaluation and Surveillance Survey ,   Essentials Instrument and Protocol Evaluation and Surveillance Survey - Revised 10JUL2025
Instrument and Protocol Implementation Capacity Assessment (ICA)	0920	Instrument and Protocol Surveillance Capacity Assessment (SCA)
Instrument and Protocol Key Informant Interview - Principal Investigators	0920	Instrument and Protocol Key Informant Interview - Principal Investigators
Instrument and Protocol Key Informant Interview - Principal Investigators/Implementer	0920	Instrument and Protocol Key Informant Interview - Principal Investigators
Instrument and Protocol Surveillance Capacity Assessment (SCA)	0920	Instrument and Protocol Key Informant Interview - Principal Investigators

---

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	72	72	0	0	0	0
Annual Time Burden (Hours)	168	168	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:

---

Annual Cost to Federal Government: $53,895

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

---

Common Form ICR:  No

---

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: 07/10/2025

---