OMB control number

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

OMB 0920-0879 · HHS/CDC.

OMB 0920-0879

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.

The latest form for [NCSTLTPHIW] Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery expires 2026-08-31 and is listed under ICR 202410-0920-015.

Latest Forms, Documents, and Supporting Material

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

OMB Details

[PHIC/NCIRD] Pediatric Hepatitis-Adenovirus Case Control Evaluation, United States 2022-2026 (24CN)

Federal Enterprise Architecture: Health - Illness Prevention

Information collection instruments
FormNameElectronic accessType
Form 0920-0879Hepatitis pediátrica de etiología desconocida - Cuestionario sobre exposiciones (entrevista a los padres)Fillable FileableForm and instruction
Form 0920-0879Hepatitis pediátrica de etiología desconocida. CONTROL del cuestionario sobre exposiciones (Entrevista a los padres)Fillable FileableForm and instruction
Form 0920-0879Pediatric Hepatitis of Unknown Etiology - Exposures Questionnaire CONTROL (Parental Interview)Fillable FileableForm and instruction
Form 0920-0879Pediatric Hepatitis of Unknown Etiology - Exposures Questionnaire (Parental Interview)Fillable FileableForm and instruction
Form 0920-0879PEDIATRIC HEPATITIS OF UNKNOWN ETIOLOGY MEDICAL RECORD ABSTRACTION FORMFillable FileableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.