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Federal forms, ICRs, and supporting documents

Information Collection Request

Evaluating Tools for Health Promotion and Disease Prevention

ICR 200502-0920-003 · OMB 0920-0684 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
7153 Evaluating Tools for Health Promotion and Disease Prevention Migrated
ICR Details
0920-0684 200502-0920-003
Historical Active
HHS/CDC
Evaluating Tools for Health Promotion and Disease Prevention
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 06/24/2005
Retrieve Notice of Action (NOA) 02/14/2005
Approved per CDC memo submitted to OMB 05/21/05.
  Inventory as of this Action Requested Previously Approved
08/31/2007 08/31/2007
20,920 0 0
5,922 0 0
0 0 0
The purpose of this study is to evaluate the clinical utility of a family history collection tool developed by the CDC by determining whether family history risk assessment, stratification, and personalized prevention messages have any impact on health behaviors and use of medical services.
None
None
No
1
IC Title Form No. Form Name
Evaluating Tools for Health Promotion and Disease Prevention
  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 20,920 0 0 20,920 0 0
Annual Time Burden (Hours) 5,922 0 0 5,922 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
Yes Part B of Supporting Statement
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.
02/14/2005