The Green Housing Study

OMB Control No: 0920-0906	ICR Reference No: 201112-0920-013
Status: Historical Active	Previous ICR Reference No: 201107-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: The Green Housing Study
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/20/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/20/2011
Terms of Clearance: Terms of clearance continue: Approval is given contengent on the understanding that CDC will submit a non-substantive change request to OMB via ROCIS before fielding translated instruments or any site-specific variations on the protocol, consent forms, or recuitment materials developed locally. Similarly, all changes to the questionnaires must be submitted to OMB.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2014	11/30/2014	11/30/2014
Responses	25,960	0	25,960
Time Burden (Hours)	2,356	0	2,356
Cost Burden (Dollars)	0	0	0

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Abstract: This is a request to add Spanish and Chinese translations of the questionnaires and documents.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act

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

Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 12

IC Title Form No. Form Name Screening Questionnaire none Screening Questionnaire Baseline Questionnaire - Home Characteristics N/A REVISED_APPENDIX_D1_Baseline (Home Characteristics)_October 20.2011 Baseline Questionnaire Part 2 - Home Characteristics N/A REVISED_APPENDIX_D2_Baseline (Part 2 Home Characteristics)_October 20.11 Baseline Questionnaire for Children none Baseline Questionnaire Children Monthly Text Messages Three and Nine Month Phone Contact none 3 and 9 Month Follow-up Six and Twelve Month Follow-up Questionnaire - for Environment none 6 and 12 month Follow-up - Environment Six and Twelve Month Follow-up Questionnaire - for Children none 6 and 12 month Follow-up Children Time / Activity Form - for Children none Time / Activity - Children Baseline Questionnaire - Demographics none Baseline Questionnaire (Demographics) Illness Checklist none Illness Checklist Time / Activity Form - for Mothers / Primary Caregivers none, N/A Time / Activity - Caregiver ,   REVISED_APPENDIX_D11_Time Activity (Mother- Primary Caregiver)_October 20.2011

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ICR Summary of Burden

	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	25,960	25,960	0	0	0	0
Annual Time Burden (Hours)	2,356	2,356	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $648,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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? Uncollected

Agency Contact: Daniel Holcomb 770 488-4472 [email protected]

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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: 12/20/2011

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