OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Adoption, Health Impact and Cost of Smoke-Free Multi-Unit Housing Policies

ICR 201210-0920-003 · OMB 0920-1004 · Historical Inactive

Forms and Documents
DocumentTypeStatusAvailability
Focus Group - Outcome-oriented - ME, MN, FL Form and Instruction New Repair queued
Focus Group - Process Oriented - ME, MN, FL Form and Instruction New Available
Resident Pre-Focus Group Survey - ME, MN, FL Form New Available
MUH Resident Focus Group Screening - ME, MN, FL Form New Repair queued
Resident Air Quality Monitoring Form and Instruction New Available
Resident Saliva Collection Form and Instruction New Available
MUH Resident Post-intervention Survey - Children's Module - LA County Form New Repair queued
MUH Resdient Post-Intervention Survey - Core - LA County Form New Available
MUH Resident Baseline Survey - Children's Module - LA County Form New Repair queued
Resident Baseline Survey -Core - LA County Form New Repair queued
MUH Resident Baseline Survey - screening LA county Form New Available
Recruitment of MUH Operators in MN, ME, FL Form and Instruction New Available
MUH Operator Post-intervention Survey Form New Repair queued
MUH Operator Baseline Survey Form New Available
Recruitment of MUH Operators in LA County Form and Instruction New Repair queued
Supporting Statement Part B_9 10 12.docx Supporting Statement B Uploaded 2012-09-24 Available
Att 14_CDC IRB Approval.docx Supplementary Document Uploaded 2012-09-27 Repair queued
Att 3D Logic Model_8 27 2012.doc Supplementary Document Uploaded 2012-09-24 Available
Att 3C_Data Collection Flow Chart.doc Supplementary Document Uploaded 2012-09-24 Repair queued
Att 3B_Sources of Survey Questions.doc Supplementary Document Uploaded 2012-09-24 Available
Att 3A_Effect Sizes.doc Supplementary Document Uploaded 2012-09-24 Repair queued
Att 2B_Summary of Public Comments.doc Supplementary Document Uploaded 2012-09-24 Repair queued
Att 2A_Federal Register Notice.pdf Supplementary Document Uploaded 2012-09-24 Available
Att 1D_PPHF.pdf Supplementary Document Uploaded 2012-09-24 Available
Att 1C_Affordable Care Act.pdf Supplementary Document Uploaded 2012-09-24 Available
Att 1B_PHSA.docx Supplementary Document Uploaded 2012-09-24 Available
Att 1A_ARRA of 2009.pdf Supplementary Document Uploaded 2012-09-24 Available
Att 13A-1_Focus Group Consent.docx Supplementary Document Uploaded 2012-09-27 Repair queued
Att 12A-2_Other Focus Group Recruitment Materials.docx Supplementary Document Uploaded 2012-09-27 Repair queued
Att 12A-1_Focus Group Recruitment Flyer.docx Supplementary Document Uploaded 2012-09-27 Repair queued
Att 11A-1(s)_Airborne Particle Data Diary_9 12 2012 .docx Supplementary Document Uploaded 2012-09-27 Available
Att 11A-1(e)_Airborne Particle Data Diary_9 12 2012.doc Supplementary Document Uploaded 2012-09-27 Repair queued
Att 10A-1(s)_Child Assent Saliva Sample_8 30 2012.docx Supplementary Document Uploaded 2012-09-27 Available
Att 10A-1(e)_Child Assent Saliva Sample.docx Supplementary Document Uploaded 2012-09-27 Repair queued
Att 8A-3(s)_LA Resident Consent for Child Questions_8 30 2012.docx Supplementary Document Uploaded 2012-09-27 Available
Att 8A-3(e)_LA Resident Consent for Child Questions.docx Supplementary Document Uploaded 2012-09-27 Repair queued
Att 8A-2(s)_LA HIPPA Form_8 30 2012.docx Supplementary Document Uploaded 2012-09-27 Available
Att 8A-2(e)_LA HIPPA Form.docx Supplementary Document Uploaded 2012-09-27 Repair queued
Att 8A-1(s)_MUH Resident Adult Consent_8 30 2012.docx Supplementary Document Uploaded 2012-09-27 Repair queued
Att 8A-1(e)_MUH Resident Adult Consent.docx Supplementary Document Uploaded 2012-09-27 Available
Att 8A-4(s)_Resident Recruitment Materials_8 30 2012.docx Supplementary Document Uploaded 2012-09-27 Repair queued
Att 8A-4(e)_Resident Recruitment Materials.docx Supplementary Document Uploaded 2012-09-27 Repair queued
Att 8A-3(s)_LA Resident Consent for Child Questions_8 30 2012.docx Supplementary Document Uploaded 2012-09-27 Repair queued
Att 8A-3(e)_LA Resident Consent for Child Questions.docx Supplementary Document Uploaded 2012-09-27 Repair queued
Att 8A-2(s)_LA HIPPA Form_8 30 2012.docx Supplementary Document Uploaded 2012-09-24 Available
Att 8A-2(e)_LA HIPPA Form.docx Supplementary Document Uploaded 2012-09-24 Repair queued
Att 8A-1(s)_MUH Resident Adult Consent_8 30 2012.docx Supplementary Document Uploaded 2012-09-24 Available
Att 8A-1(e)_MUH Resident Adult Consent.docx Supplementary Document Uploaded 2012-09-24 Repair queued
Att 6A-1_LMUH Operator Survey Consent LA.docx Supplementary Document Uploaded 2012-09-24 Available
Att 6A-2_MUH Operator Survey Consent MN ME FL.docx Supplementary Document Uploaded 2012-09-24 Available
Att 4A-1_Letter to Property Management.docx Supplementary Document Uploaded 2012-09-24 Repair queued
Supporting Statement Part A_9 10 12.docx Supporting Statement A Uploaded 2012-09-24 Available
IC Document Collections
IC IDCollectionTypeStatusForm
204450 Focus Group - Outcome-oriented - ME, MN, FL Form and Instruction New
204449 Focus Group - Process Oriented - ME, MN, FL Form and Instruction New
204448 Resident Pre-Focus Group Survey - ME, MN, FL Form New
204447 MUH Resident Focus Group Screening - ME, MN, FL Form New
204446 Resident Air Quality Monitoring Form and Instruction New
204445 Resident Saliva Collection Form and Instruction New
204444 MUH Resident Post-intervention Survey - Children's Module - LA County Form New
204443 MUH Resdient Post-Intervention Survey - Core - LA County Form New
204442 MUH Resident Baseline Survey - Children's Module - LA County Form New
204441 Resident Baseline Survey -Core - LA County Form New
204440 MUH Resident Baseline Survey - screening LA county Form New
204439 Recruitment of MUH Operators in MN, ME, FL Form and Instruction New
204438 MUH Operator Post-intervention Survey Form New
204437 MUH Operator Baseline Survey Form New
204436 Recruitment of MUH Operators in LA County Form and Instruction New
ICR Details
0920-1004 201210-0920-003
Historical Inactive
HHS/CDC
Adoption, Health Impact and Cost of Smoke-Free Multi-Unit Housing Policies
New collection (Request for a new OMB Control Number)   No
Regular
Improperly submitted 10/10/2012
Retrieve Notice of Action (NOA) 10/10/2012
  Inventory as of this Action Requested Previously Approved
24 Months From Approved
0 0 0
0 0 0
0 0 0
CDC plans to conduct a quasi-experimental pretest, posttest design study with an intervention group and a comparison group to study the impact of smoke-free housing policies in multi-unit residential housing facilities. The study will include surveys of MUH operators and residents, objective measures of air quality and tobacco exposure, and focus groups with residents.
PL: Pub.L. 111 - 5 VIII Name of Law: ARRA
   PL: Pub.L. 111 - 148 4002 Name of Law: Patient Protection and ACA, Prevention and Public Health Fund
   US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  77 FR 17065 03/23/2012
77 FR 61407 10/09/2012
Yes
15
IC Title Form No. Form Name
Recruitment of MUH Operators in LA County none Recruitment Script for MUH Operators in LA County
MUH Operator Baseline Survey none MUH Operator Baseline Survey
MUH Operator Post-intervention Survey none Post-intervention Survey
Recruitment of MUH Operators in MN, ME, FL none Recruitment Script for MUH Operators
MUH Resident Baseline Survey - screening LA county none, none Resident Baseline Survey - screener - English ,   Resident Baseline Survey - screener Spanish
Resident Baseline Survey -Core - LA County none, none Resident Baseline Survey - LA County - English ,   Resident Baseline Survey - LA County - Spanish
MUH Resident Baseline Survey - Children's Module - LA County none, none Resident Survey - Children's Module - LA County -English ,   Resident Survey - Children's Module -LA County - Spanish
MUH Resdient Post-Intervention Survey - Core - LA County none Resident Post-Intervention Survey
MUH Resident Post-intervention Survey - Children's Module - LA County none Resident Post-intervention - Children's Module - English
Resident Saliva Collection none Saliva Collection
Resident Air Quality Monitoring none, none Air Quality Monitoring Protocol ,   Air Quality Monitoring Protocol - Spanish
MUH Resident Focus Group Screening - ME, MN, FL none Focus Group Screening
Resident Pre-Focus Group Survey - ME, MN, FL none Pre-Focus Group Survey
Focus Group - Process Oriented - ME, MN, FL none Process-oriented Focus Group
Focus Group - Outcome-oriented - ME, MN, FL none Outcome-oriented Focus Group
Yes
Miscellaneous Actions
No
This is a new ICR.
$2,028,456
Yes Part B of Supporting Statement
Yes
Yes
No
Yes
Uncollected
Shari Steinberg 404 639-4942 [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.
10/10/2012