OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Pilot Study of Community-Based Surveillance of Supports for Healthy Eating/Active Living (HE/AL)

ICR 201202-0920-003 · OMB 0920-0934 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
CBS Survey Form New Available
CBS OMB Part B 01_19_12.doc Supporting Statement B Uploaded 2012-01-24 Available
Appendix D3. Participant Consent Form 01_19_12.docx Supplementary Document Uploaded 2012-01-24 Available
Appendix D1. Study Invitation Letter 01_19_12.doc Supplementary Document Uploaded 2012-01-24 Available
Appendix D2. Study Fact Sheet 01_19_12.doc Supplementary Document Uploaded 2012-01-24 Available
Appendix F. References 01_09_12.doc Supplementary Document Uploaded 2012-01-24 Available
Appendix E. Example Tables 01_09_12.doc Supplementary Document Uploaded 2012-01-24 Available
Appendix B2. Summary of Public Comments.doc Supplementary Document Uploaded 2012-01-24 Available
Appendix B1. Federal Register Notice.pdf Supplementary Document Uploaded 2012-01-24 Available
Appendix A. Supporting Legislation.doc Supplementary Document Uploaded 2012-01-24 Repair queued
Appendix D5. Instructions 01_19_12.doc Supplementary Document Uploaded 2012-01-24 Available
CBS OMB Part A 01_19_12.doc Supporting Statement A Uploaded 2012-01-24 Available
IC Document Collections
IC IDCollectionTypeStatusForm
201063 Telephone Non-Response Follow-up Contact Script Other-Telephone Script New
201062 CBS Survey Form New
ICR Details
0920-0934 201202-0920-003
Historical Active
HHS/CDC
Pilot Study of Community-Based Surveillance of Supports for Healthy Eating/Active Living (HE/AL)
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 05/07/2012
Retrieve Notice of Action (NOA) 02/08/2012
  Inventory as of this Action Requested Previously Approved
05/31/2013 12 Months From Approved
1,000 0 0
450 0 0
0 0 0
The Centers for Disease Control and Prevention requests approval to conduct a pilot study, to examine the feasibility of establishing a new national surveillance system that will monitor local government policies which support healthy eating and active living.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  76 FR 62068 10/06/2011
77 FR 5519 02/03/2012
Yes
2
IC Title Form No. Form Name
CBS Survey none, none CBS Questionnaire ,   Survey Screenshots
Telephone Non-Response Follow-up Contact Script
  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 1,000 0 0 1,000 0 0
Annual Time Burden (Hours) 450 0 0 450 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new data collection.
$345,120
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Tony Richardson 404 639-4965 [email protected]
  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.
02/08/2012