[ATSDR] APPLETREE Performance Measures

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
ATSDR Requests for Certified PHAs/HCs	Form and Instruction	Modified	Available
ATSDR Recommendation Follow-up Form	Form and Instruction	Modified	Available
ATSDR SoilSHOP Form	Form and Instruction	Modified	Available
CSPECE Quantitative Form	Form and Instruction	Modified	Available
CSPECE Qualitative Narrative Reporting Supplement	Form and Instruction	Modified	Available
Success Story Form (screenshots)	Form and Instruction	Modified	Available
APPLETREE Annual Performance Report (APR)	Form and Instruction	Modified	Available
Site Impact Assessment Form	Form and Instruction	Modified	Available
Technical Assist Details (screenshots)	Form and Instruction	Modified	Available
Health Education (screenshots)	Form and Instruction	Modified	Available
Att2b Public Comment Response Letter.docx	Public Comments	Uploaded 2026-06-26	Available
Att2a Public Comment.docx	Public Comments	Uploaded 2026-06-26	Available
Att6. 2026 Research Determination 60D clearance.pdf	Supplementary Document	Uploaded 2026-10-20	Available
Att5 NEPHTN_Privacy_Assessment_2026.pdf	Supplementary Document	Uploaded 2026-10-20	Available
Att3 APPLETREE NOFO.pdf	Supplementary Document	Uploaded 2026-10-20	Available
Att2 60D FRN_0923-0057_2026.pdf	Supplementary Document	Uploaded 2026-10-20	Available
Att1 Authorizing Legislation CERCLA.pdf	Supplementary Document	Uploaded 2026-10-20	Available
1 - SSB APPLETREE PMs 2026_final.docx	Supporting Statement B	Uploaded 2026-10-20	Available
1 - SSA APPLETREE PMs 2026 clean2_final.docx	Supporting Statement A	Uploaded 2026-10-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
262208	ATSDR Requests Form	Form and Instruction	Modified	ATSDR Requests for Certified PHAs/HCs
241391	ATSDR Recommendation Follow-up	Form and Instruction	Modified	ATSDR Recommendation Follow-up Form
241388	ATSDR SoilSHOPS Form	Form and Instruction	Modified	ATSDR SoilSHOP Form
241385	CSPECE Quantitative Form	Form and Instruction	Modified	CSPECE Quantitative Form
241384	CSPECE Qualitative Narrative Form	Form and Instruction	Modified	CSPECE Qualitative Narrative Reporting Supplement
226338	ATSDR Success Story Form	Form and Instruction	Modified	Success Story Form (screenshots)
226337	APPLETREE Annual Progress Report (APR)	Form and Instruction	Modified	APPLETREE Annual Performance Report (APR)
226336	ATSDR Site Impact Assessment Form	Form and Instruction	Modified	Site Impact Assessment Form
226335	ATSDR Technical Assistance (TA) Activity Form	Form and Instruction	Modified	Technical Assist Details (screenshots)
226334	ATSDR Health Education Activity Tracking (HEAT) Form	Form and Instruction	Modified	Health Education (screenshots)

ICR Details

OMB Control No: 0923-0057	ICR Reference No: 202610-0923-001
Status: Received in OIRA	Previous ICR Reference No: 202309-0923-001
Agency/Subagency: HHS/TSDR	Agency Tracking No: 0923-26-0236
Title: [ATSDR] APPLETREE Performance Measures
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/20/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2026
Responses	1,540	1,540
Time Burden (Hours)	336	269
Cost Burden (Dollars)	0	0

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Abstract: Under the APPLETREE cooperative agreement (CDC-RFA-TS17-1701), ATSDR collects information related to Awardee activities and the process and outcome performance measures. Information will be used to monitor progress toward program goals and objectives, and for quality improvement. The revision includes a minor increase in burden but no significant changes in the content of the forms.

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Authorizing Statute(s): PL: Pub.L. 107 - 377 104(i)(15) Name of Law: Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA)
  

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 38712	06/26/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 66333	10/20/2026
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
APPLETREE Annual Progress Report (APR)	n/a	APPLETREE Annual Performance Report (APR)
ATSDR Health Education Activity Tracking (HEAT) Form	n/a	Health Education (screenshots)
ATSDR Recommendation Follow-up	n/a	ATSDR Recommendation Follow-up Form
ATSDR Requests Form	n/a	ATSDR Requests for Certified PHAs/HCs
ATSDR Site Impact Assessment Form	n/a	Site Impact Assessment Form
ATSDR SoilSHOPS Form	n/a	ATSDR SoilSHOP Form
ATSDR Success Story Form	n/a	Success Story Form (screenshots)
ATSDR Technical Assistance (TA) Activity Form	n/a	Technical Assist Details (screenshots)
CSPECE Qualitative Narrative Form	n/a	CSPECE Qualitative Narrative Reporting Supplement
CSPECE Quantitative Form	n/a	CSPECE Quantitative Form

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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	1,540	1,540	0	0	0	0
Annual Time Burden (Hours)	336	269	0	67	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: Increase in burden is due to adjustment of two burden estimates.

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Annual Cost to Federal Government: $14,715,384

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.     Yes

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: 10/20/2026

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