OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Pre-Evaluation Assessments of Nutrition, Physical Activity and Obesity Programs and Policies

ICR 201201-0920-009 · OMB 0920-0927 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 3 Lead Administrator Site Visit Schedule and Intructions Form and Instruction New Repair queued
Form 2 Lead Administrator -- Site Visit Availability Calendar Form New Available
Form 4 Lead Administrator--Suggested Interviewees Form Form and Instruction New Available
Form 1 Nomination Form and Instruction New Available
SS-Part B 01 10 2012.doc Supporting Statement B Uploaded 2012-01-19 Available
Att 12_ORAL INFORMED CONSENT STATEMENT.doc Supplementary Document Uploaded 2012-01-20 Available
Att 11_NON-DISCLOSURE AGREEMENT.doc Supplementary Document Uploaded 2012-01-20 Repair queued
Att 10_ENVIRONMENTAL OBSERVATION GUIDE.doc Supplementary Document Uploaded 2012-01-20 Available
Att 13_EXPERT CONSULTANTS SITE SELECTION GUIDANCE DOCUMENT.doc Supplementary Document Uploaded 2012-01-20 Available
Att 3_DNPAO Recommended community_strategies_guide.pdf Supplementary Document Uploaded 2012-01-19 Available
Att 2B_Summary of Public Comments.doc Supplementary Document Uploaded 2012-01-19 Available
Att 1_ Authorizing Legislation.doc Supplementary Document Uploaded 2012-01-19 Available
Att 5D_Site Visit FAQs.doc Supplementary Document Uploaded 2012-01-20 Available
Att 5C_Notification Email and Letter.doc Supplementary Document Uploaded 2012-01-20 Repair queued
Att 4C_Nomination Solicitation Email.doc Supplementary Document Uploaded 2012-01-19 Repair queued
SS-Part A 01 10 2012.doc Supporting Statement A Uploaded 2012-01-19 Available
IC Document Collections
IC IDCollectionTypeStatusForm
200885 Lead Administrator Site Visit Schedule and Intructions Form and Instruction New
200884 Lead Administrator -- Site Visit Availability Calendar Form New
200883 Private Sector Partner Interviews Instruction New
200882 Public Sector Partner Interviews Instruction New
200881 Program Staff Interview Instruction New
200880 Evaluator Interview Instruction New
200879 Lead Administrator--Suggested Interviewees Form Form and Instruction New
200878 Lead Administrator Interview Guide Instruction New
200877 Nomination Form and Instruction New
ICR Details
0920-0927 201201-0920-009
Historical Active
HHS/CDC
Pre-Evaluation Assessments of Nutrition, Physical Activity and Obesity Programs and Policies
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 03/30/2012
Retrieve Notice of Action (NOA) 01/23/2012
  Inventory as of this Action Requested Previously Approved
03/31/2014 24 Months From Approved
231 0 0
291 0 0
0 0 0
CDC will collect information to identify promising community-based strategies to prevent obesity by improving nutrition and physical activity. Program strategies selected for assessment must be based on CDC guidance.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  76 FR 54472 09/01/2011
77 FR 2730 01/19/2012
Yes
  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 231 0 0 231 0 0
Annual Time Burden (Hours) 291 0 0 291 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new, one-time information collection. The number of program initiatives selected for pre-evaluation assessment may increase if additional funding becomes available.
$410,949
Yes Part B of Supporting Statement
Yes
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.
01/23/2012