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Information Collection Request

Evaluation of a Concussion Tool Kit - Heads Up: Concussion in High School Sports

ICR 200411-0920-001 · OMB 0920-0674 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
7142 Evaluation of a Concussion Tool Kit - Heads Up: Concussion in High School Sports Migrated
ICR Details
0920-0674 200411-0920-001
Historical Active
HHS/CDC
Evaluation of a Concussion Tool Kit - Heads Up: Concussion in High School Sports
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 01/31/2005
Retrieve Notice of Action (NOA) 11/08/2004
Approved consistent with CDC memo forwarded to OMB 01/21/05. OMB approves state to state comparisons discussed in the study protocol for exploratory purposes only. OMB will provide approval of the collection for a three year period at CDC's request in order to include a follow up component to the requested study. CDC should submit a change worksheet to OMB to request additional burden hours and respondents for follow up measures as well as a copy of the follow up instrument and a discussion of the prospective survey protocol. In the event that budgetary constraints do not allow for follow up, CDC should submit a discontinuation form to OMB after completion of the initial phase of the study.
  Inventory as of this Action Requested Previously Approved
01/31/2008 01/31/2008
4,045 0 0
301 0 0
0 0 0
Every year about 1.5 Americans sustain a traumatic brain injury (TBI) of those it's estimated that 300,000 are sports-related. NCIPC has developed a tool kit for coaches and plans to distribute the kit nationally. The tool kit is made up of materials in English and Spanish, a pocket card for quick references, a video and fact sheets for coaches and parents. The aim is to raise awareness and educate coaches about concussion; help coaches educate their athletes, parents, and other school officials about concussion. This study will pilot est the coaches tool kit and provide feedback.....
None
None
No
1
IC Title Form No. Form Name
Evaluation of a Concussion Tool Kit - Heads Up: Concussion in High School Sports
  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 4,045 0 0 4,045 0 0
Annual Time Burden (Hours) 301 0 0 301 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
11/08/2004