[NCIPC] DELTA Achieving Health Equity through Addressing Disparities (AHEAD) COOPERATIVE AGREEMENT EVALUATION

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-1412 Prevention Infrastructure Assessment Tool - 11JUL2025	Form and Instruction	Removed	Available
Form 0920-23AA Att. 5a Prevention Infrastructure Assessment Tool Updated	Form and Instruction	Removed	Available
Form 0920-1412 Key Informant Interview Protocol - Evaluator - 11JUL2025	Form and Instruction	Removed	Available
Form 0920-23AA Att. 4b Key Informant Interview Protocol - Evaluator	Form and Instruction	Removed	Available
Form 0920-1412 Key Informant Interview Protocol - Project Lead - 11JUL2025	Form and Instruction	Removed	Available
Form 0920-23AA Att. 4a Key Informant Interview Protocol - Project Lead	Form and Instruction	Removed	Available
Form 0920-26-0119 Annual Performance Report	Form and Instruction	Modified	Available
Att. 5 PIA 0920-1412 DELTA.pdf	Supplementary Document	Uploaded 2026-06-22	Available
Att 2b DELTA_Comment_ response.pdf	Public Comments	Uploaded 2026-06-22	Available
Att. 4 DELTA Research Determination.pdf	Supplementary Document	Uploaded 2026-06-22	Available
Att. 1 - Authorizing Legislation - FVPSA 42 USC 10414.pdf	Supplementary Document	Uploaded 2026-06-22	Available
Change Request Memo - 0920-1412.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-07-11	Available
Att. 5b Prevention Infrastructure Assessment Screenshots Updated.pdf	Supplementary Document	Uploaded 2023-06-12	Available
Att. 3b DELTA AHEAD APR Screenshots.docx.pdf	Supplementary Document	Uploaded 2023-06-12	Available
Att. 1 - Authorizing Legislation - FVPSA 42 USC 10414.pdf	Supplementary Document	Uploaded 2023-06-12	Available
SSA - 0920-1412 DELTA final.docx	Supporting Statement A	Uploaded 2026-06-22	Available
SSB 0920-1412 DELTA.docx	Supporting Statement B	Uploaded 2026-06-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
260626	Prevention Infrastructure Assessment	Form and Instruction	Removed	Prevention Infrastructure Assessment Tool - 11JUL2025
260626	Prevention Infrastructure Assessment	Form and Instruction	Removed	Att. 5a Prevention Infrastructure Assessment Tool Updated
260625	Key Informant Interview Evaluator	Form and Instruction	Removed	Key Informant Interview Protocol - Evaluator - 11JUL2025
260625	Key Informant Interview Evaluator	Form and Instruction	Removed	Att. 4b Key Informant Interview Protocol - Evaluator
260624	Key Informant Interview – Project Lead	Form and Instruction	Removed	Key Informant Interview Protocol - Project Lead - 11JUL2025
260624	Key Informant Interview – Project Lead	Form and Instruction	Removed	Att. 4a Key Informant Interview Protocol - Project Lead
260623	Annual Performance Report	Form and Instruction	Modified	Annual Performance Report

ICR Details

OMB Control No: 0920-1412	ICR Reference No: 202606-0920-012
Status: Received in OIRA	Previous ICR Reference No: 202507-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-26-0119
Title: [NCIPC] DELTA Achieving Health Equity through Addressing Disparities (AHEAD) COOPERATIVE AGREEMENT EVALUATION
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/22/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2026
Responses	13	42
Time Burden (Hours)	130	158
Cost Burden (Dollars)	0	0

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Abstract: The purpose of this data collection is to collect monitoring data project performance and implementation of cooperative agreement for Domestic Violence Prevention Enhancement and Leadership Through Alliances (DELTA) Achieving Health Equity through Addressing Disparities (AHEAD). Information collected from recipients on state- and local-level will provide crucial data for performance monitoring of the cooperative agreement and will provide CDC with the capacity to respond in a timely manner to requests for information about the program from the Department of Health and Human Services (HHS), the White House, Congress, and other sources. Recipients will report progress and activity information to CDC on an annual schedule using a web-based Partners’ Portal and web-based survey tool. In this revision, substantial changes were made to this ICR revision to streamline the reporting process and update language in alignment with Executive Orders and CDC priorities. In addition, supplemental data collection instruments (4a, 4b, 5a, and 5b) were removed due to staffing constraints.

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Authorizing Statute(s): None

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 36832	06/18/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 14023	03/24/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Annual Performance Report	0920-26-0119	Annual Performance Report
Key Informant Interview Evaluator	0920-1412, 0920-23AA	Att. 4b Key Informant Interview Protocol - Evaluator ,   Key Informant Interview Protocol - Evaluator - 11JUL2025
Key Informant Interview – Project Lead	0920-1412, 0920-23AA	Att. 4a Key Informant Interview Protocol - Project Lead ,   Key Informant Interview Protocol - Project Lead - 11JUL2025
Prevention Infrastructure Assessment	0920-23AA, 0920-1412	Att. 5a Prevention Infrastructure Assessment Tool Updated ,   Prevention Infrastructure Assessment Tool - 11JUL2025

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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	13	42	0	0	-29	0
Annual Time Burden (Hours)	130	158	0	0	-28	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: This is a revision to a previously approved collection seeking three years of approval and 130 annual burden hours.

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Annual Cost to Federal Government: $44,576

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: 06/22/2026

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