OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Evaluation of Core Violence and Injury Prevention Program

ICR 201112-0920-002 · OMB 0920-0916 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 4 Core VIPP Non-Funded SHD: SOTS Financial Module Form and Instruction New Available
Form 3 Core VIPP Funded SHD: SOTS Financial Module Form and Instruction New Available
Form 2 Core VIPP Non-funded State Health Department State of the States Survey Form and Instruction New Available
Form 1 Core VIPP Funded State Health Department--State of the States Survey Form and Instruction New Available
Supporting Statement B -11-17-2011.docx Supporting Statement B Uploaded 2011-12-01 Available
Attachment B - 60-Day FRN - PUBLISHED.pdf Supplementary Document Uploaded 2011-12-01 Available
Attachment A-TITLE 42--THE PUBLIC HEALTH AND WELFARE.docx Supplementary Document Uploaded 2011-12-01 Repair queued
Supporting Statement A -11-17-2011.docx Supporting Statement A Uploaded 2011-12-02 Available
IC Document Collections
IC IDCollectionTypeStatusForm
200347 Core VIPP Non-Funded SHD: SOTS Financial Module Form and Instruction New
200346 Core VIPP Funded SHD: SOTS Financial Module Form and Instruction New
200345 Core VIPP Funded SHD: Telephone Interview Other-Telephone interview questions for Core VIPP Evaluation New
200344 Core VIPP Non-funded State Health Department State of the States Survey Form and Instruction New
200343 Core VIPP Funded State Health Department--State of the States Survey Form and Instruction New
ICR Details
0920-0916 201112-0920-002
Historical Active
HHS/CDC
Evaluation of Core Violence and Injury Prevention Program
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 01/16/2012
Retrieve Notice of Action (NOA) 12/06/2011
  Inventory as of this Action Requested Previously Approved
01/31/2014 24 Months From Approved
128 0 0
242 0 0
0 0 0
The purpose of this ICR is to permit CDC to evaluate the Core VIPP program for the benefit of the Core VIPP grantees. This ICR has two overall goals: (1) to assess state injury and violence prevention plans for completeness, measurability, and effectiveness; and (2) evaluate the effectiveness of the Core VIPP cooperative agreement.
US Code: 42 USC 241 Name of Law: The Public Health and Welfare
  
None
Not associated with rulemaking
  76 FR 41798 07/15/2011
76 FR 74066 11/30/2011
No
  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 128 0 0 128 0 0
Annual Time Burden (Hours) 242 0 0 242 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is new ICR.
$425,399
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Petunia Gissendaner 4046390164
  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.
12/06/2011