OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Targeted Surveillance and Biometric Studies for Enhanced Evaluation of CTGs

ICR 201208-0920-003 · OMB 0920-0977 · Historical Inactive

Forms and Documents
DocumentTypeStatusAvailability
Adult Targeted Surveillance Survey Recruitment Screener Form New Repair queued
Youth Survey Form New Available
Youth Survey Recruitment Screener for Youth Form New Available
Youth Activity Diary Form New Available
Child or Youth Biometric Measures Form New Repair queued
Caregiver Activity Diary (on behalf of young child) Form New Repair queued
Caregiver Survey Form New Available
Caregiver Survey Recruitment Screener Form New Repair queued
Adult Activity Diary and Reminder Form New Available
Adult Biometric Measures Form New Repair queued
Youth Survey Recruitment Screener for Parent/Guardian Form New Available
Adult Biometric Measures Recruitment Screener (In-person) Form New Available
Adult Biometric Measures Recruitment Screener (phone/paper) Form New Available
Adult Targeted Surveillance Survey Form New Repair queued
0920-12IG_Part_B_7-23-12.doc Supporting Statement B Uploaded 2012-08-07 Available
Att S6B_Consent (Phone) Spanish.docx Supplementary Document Uploaded 2012-08-07 Repair queued
Att S6A_Consent (Paper) Spanish.docx Supplementary Document Uploaded 2012-08-07 Repair queued
Att S11B_ATSS_Postcard Spanish.doc Supplementary Document Uploaded 2012-08-07 Repair queued
Att 11B_ATSS_ReminderPostcard.doc Supplementary Document Uploaded 2012-08-07 Available
Att S11A_ATSS_LeadLetterSpanish.doc Supplementary Document Uploaded 2012-08-07 Available
Att 11A_ATSS_LeadLetter.doc Supplementary Document Uploaded 2012-08-07 Available
Att 7_DataCollectionFlow04.wmf Supplementary Document Uploaded 2012-08-07 Repair queued
Att 6B_ATSS_Consent(Phone).doc Supplementary Document Uploaded 2012-08-01 Available
Att 6A_Consent(Paper).doc Supplementary Document Uploaded 2012-08-01 Repair queued
Att 5_DataSources.doc Supplementary Document Uploaded 2012-08-01 Available
Att 4C_ListofCTGAwardees.docx Supplementary Document Uploaded 2012-07-26 Repair queued
Att 4B_CTGEvaluationPlan.doc Supplementary Document Uploaded 2012-07-26 Available
Att 4A_StrategicDirections.docx Supplementary Document Uploaded 2012-07-26 Available
Att 3B_IRBApproval_YABS.pdf Supplementary Document Uploaded 2012-07-26 Available
Att 3A_IRBApproval_ATSS.pdf Supplementary Document Uploaded 2012-07-26 Available
Att 2_60-dayFRN.pdf Supplementary Document Uploaded 2012-07-26 Available
Att 1B_ACASection4201.doc Supplementary Document Uploaded 2012-07-26 Repair queued
Att 1A_PHSA.pdf Supplementary Document Uploaded 2012-07-26 Available
Att S13A_Accelerometry Instructions Spanish.docx Supplementary Document Uploaded 2012-08-07 Available
Att 13A_Accelerometry Instructions.docx Supplementary Document Uploaded 2012-08-07 Repair queued
Att S8B_ATSS FAQGuide Spanish.doc Supplementary Document Uploaded 2012-08-07 Available
Att 8B_ATSS_FAQGuide.docx Supplementary Document Uploaded 2012-08-07 Repair queued
0920-12IG_Part_A_7-23-12.doc Supporting Statement A Uploaded 2012-08-07 Available
IC Document Collections
IC IDCollectionTypeStatusForm
203638 Adult Targeted Surveillance Survey Recruitment Screener Form New
203637 Youth Survey Form New
203636 Youth Survey Recruitment Screener for Youth Form New
203635 Youth Activity Diary Form New
203634 Child or Youth Biometric Measures Form New
203633 Caregiver Activity Diary (on behalf of young child) Form New
203632 Caregiver Survey Form New
203631 Caregiver Survey Recruitment Screener Form New
203630 Adult Activity Diary and Reminder Form New
203629 Adult Biometric Measures Form New
203628 Youth Survey Recruitment Screener for Parent/Guardian Form New
203627 Adult Biometric Measures Recruitment Screener (In-person) Form New
203626 Adult Biometric Measures Recruitment Screener (phone/paper) Form New
203625 Adult Targeted Surveillance Survey Form New
ICR Details
0920-0977 201208-0920-003
Historical Inactive
HHS/CDC
Targeted Surveillance and Biometric Studies for Enhanced Evaluation of CTGs
New collection (Request for a new OMB Control Number)   No
Regular
Withdrawn 11/19/2012
Retrieve Notice of Action (NOA) 08/07/2012
Withdrawn as discussed on 11/19/2012 call.
  Inventory as of this Action Requested Previously Approved
36 Months From Approved
0 0 0
0 0 0
0 0 0
CDC requests approval to collect information to analyze trends in behavioral and biometric indicators of risk factors for chronic disease in communities funded through the Community Transformation Grant (CTG) Program. Priority will be given to assessment of weight, diet, physical activity, tobacco use, and exposure to secondhand smoke in CTG-funded communities.
US Code: 42 USC 241 Name of Law: Public Health Service Act
   US Code: 4 USC 4201 Name of Law: Community Transformation Grants
  
None
Not associated with rulemaking
  77 FR 23263 04/18/2012
77 FR 47073 08/07/2012
No
14
IC Title Form No. Form Name
Caregiver Survey Recruitment Screener none, none Caregiver Screener ,   Spanish Caregiver Screener
Adult Targeted Surveillance Survey none, none Adult Targeted Survey ,   Spanish Adult Targeted Survey
Adult Biometric Measures Recruitment Screener (phone/paper) none, none Biometric Screener ,   Spanish Biometric Screener
Adult Biometric Measures Recruitment Screener (In-person) none, none Biometric Screener in-person ,   Spanish Biometric Screener in-person
Youth Survey Recruitment Screener for Parent/Guardian none, none Youth Survey Recruitment Screener for Parent ,   Spanish Youth Survey Recruitment Screener for Parent
Adult Biometric Measures none, none Adult Biometric Measures ,   Spanish Adult Biometric Measures
Adult Activity Diary and Reminder none, none Adult Activity Diary ,   Spanish Adult Activity Diary
Caregiver Survey none, none Caregiver Survey ,   Spanish Caregiver Survey
Caregiver Activity Diary (on behalf of young child) none, none Youth Caregiver Activity Diary ,   Spanish Youth Caregiver Activity Diary
Child or Youth Biometric Measures none, none, none, none Biometric Measures Age 12-17 ,   Biometric Measures Ages 3-11 ,   Spanish Biometric Measure Age 12-17 ,   Spanish Biometric Measure Age 3-11
Youth Activity Diary none, none Youth Activity Diary ,   Spanish Youth Activity Diary
Youth Survey Recruitment Screener for Youth none, none Survey Recruitment Screener for Youth ,   Spanish Survey Recruitment Screener for Youth
Youth Survey none, none Youth Survey ,   Spanish - Youth Survey
Adult Targeted Surveillance Survey Recruitment Screener none, none Adult Targeted Survey Screener ,   Spanish Adult Targeted Survey Screener
Yes
Miscellaneous Actions
No
This is a new ACA related data collection supporting evaluation of a new programmatic initiative.
$5,037,366
Yes Part B of Supporting Statement
No
Yes
No
No
Uncollected
Carol Walker 4046394773
  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.
08/07/2012