[NCEH] Poison Center Collaborations for Public Health Emergencies

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Att7_Example Parent-Child Questionnaire.docx	Supplementary Document	Uploaded 2026-04-15	Available
Att6_Example Adolescent Questionnaire.docx	Supplementary Document	Uploaded 2026-04-15	Available
Att5_Example Adult Questionnaire.docx	Supplementary Document	Uploaded 2026-04-15	Available
Att2c1_Public Comment Response 3.docx	Public Comments	Uploaded 2026-04-15	Available
Att2c_CDC-2025-1014-0003.pdf	Public Comments	Uploaded 2026-04-15	Available
Att2b1_Public Comment Response 2.docx	Public Comments	Uploaded 2026-04-15	Available
Att2b_CDC-2025-1014-0002.pdf	Public Comments	Uploaded 2026-04-15	Available
Att2a1_ Public Comment Response 1.pdf	Public Comments	Uploaded 2026-04-15	Available
Att2a_CDC-2025-1014-0004.pdf	Public Comments	Uploaded 2026-04-15	Available
Att8_Example Web Questionnaire.pdf	Supplementary Document	Uploaded 2026-04-15	Available
Att16_NCEH Research and PRA Determination.pdf	Supplementary Document	Uploaded 2026-04-15	Available
Att15_Agreemnt Prohibit Identifiers.pdf	Supplementary Document	Uploaded 2026-04-15	Available
Att13_Burden Memo PCCPHE.docx	Supplementary Document	Uploaded 2026-04-15	Available
Att12_Sample Consent and Assent Forms.docx	Supplementary Document	Uploaded 2026-04-15	Available
Att11_GenIC Rqst Apprvl Form PCCPHE.docx	Supplementary Document	Uploaded 2026-04-15	Available
Att10_Advanced Notification Email for OMB.docx	Supplementary Document	Uploaded 2026-04-15	Available
Att9_Step-by-Step How to Use the Generic Clearance.docx	Supplementary Document	Uploaded 2026-04-15	Available
Att4_Data Licensing Agreement.pdf	Supplementary Document	Uploaded 2026-04-15	Available
Att2_0920-1166_60D FRN.pdf	Supplementary Document	Uploaded 2026-04-15	Available
Att1 Authorizing Legislation.pdf	Supplementary Document	Uploaded 2026-04-15	Available
1 - List of Attachments PCCPHE_2026.docx	Supplementary Document	Uploaded 2026-04-15	Available
SSB PCCPHE Revision_March 2026_CDC.docx	Supporting Statement B	Uploaded 2026-04-15	Available
SSA_0920-1166 [NCEH] March 2026_CDC.docx	Supporting Statement A	Uploaded 2026-04-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form

ICR Details

OMB Control No: 0920-1166	ICR Reference No: 202603-0920-016
Status: Received in OIRA	Previous ICR Reference No: 202211-0920-012
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-26-0162
Title: [NCEH] Poison Center Collaborations for Public Health Emergencies
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 04/16/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	04/30/2026
Responses	1,500	1,500
Time Burden (Hours)	250	250
Cost Burden (Dollars)	0	0

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Abstract: The goal of this information collection is to create a timely mechanism which will allow a network of regional, state, and local poison centers, supported by CDC, to obtain critical exposure and health information during a public health emergency. This additional information will improve public health response for the site-specific public health emergency or incident. As questions will be tailored to the nature of the public health emergency/incident—a generic mechanism is being employed for collections within this scope to permit rapid response to urgent public health problems. Data collection instruments and methods must be rapidly created and implemented to direct appropriate public health action. Data collection for investigations conducted under this generic will not exceed 60 days. This is a revision Generic ICR. The following minor changes were made by updating web-based questionnaire development from EpiInfo TM to REDCap, and updating the number of poison centers from 55 to 53.

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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:
	91 FR 1796	01/15/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 19140	04/14/2026
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 0

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ICR Summary of Burden

table that charts list 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	1,500	1,500	0	0	0	0
Annual Time Burden (Hours)	250	250	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: $122,784

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: 04/16/2026

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