OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Epidemiologic Study of Health Effects Associated with Low Pressure Events in Drinking Water Distribution Systems

ICR 201211-0920-008 · OMB 0920-0960 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Line Listings (Pilot) Form New Available
LPE Form and Samples (Pilot) Form New Available
Line Listings (Multi-site) Form New Repair queued
LPE Form and Samples ( Multi-Site) Form New Available
Paper-Based Questionnaire (Pilot and Mult-site) Form New Available
Web-Based Questionnaire (Pilot and Multi-site) Form New Available
OMB Appendix N IRB Approval Continuation Memo.pdf Supplementary Document Uploaded 2013-03-22 Available
OMB Appendix M Utility customer information.docx Supplementary Document Uploaded 2013-03-22 Available
OMB Appendix K Final appeal letter.docx Supplementary Document Uploaded 2013-03-22 Available
OMB Appendix J Replacement survey mailing cover letter.docx Supplementary Document Uploaded 2013-03-22 Available
OMB Appendix I Thank You Reminder notecard text.pdf Supplementary Document Uploaded 2013-03-22 Available
OMB Appendix F Consent brochure.pdf Supplementary Document Uploaded 2013-03-22 Available
OMB Appendix E Cover letter initial survey mailing.docx Supplementary Document Uploaded 2013-03-22 Available
OMB Appendix D Advance letter.docx Supplementary Document Uploaded 2013-03-22 Available
OMB Appendix C Pilot evaluation logical framework.pdf Supplementary Document Uploaded 2013-03-21 Available
Supporting Statement Part B Revised 3-15-2013 water distribution.docx Supporting Statement B Uploaded 2013-03-22 Available
OMB Appendix M Utility customer information.docx Supplementary Document Uploaded 2013-03-22 Available
OMB Appendix B Federal Register 60 day notice 2012-7020.pdf Supplementary Document Uploaded 2013-03-22 Repair queued
OMB Appendix A Authorizing Legislation 42 CFR 241.pdf Supplementary Document Uploaded 2013-03-22 Available
Supporting Statement Part A Revised 3-15-2013 water distribution.docx Supporting Statement A Uploaded 2013-03-22 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
204806 Line Listings (Pilot) Form New
204805 LPE Form and Samples (Pilot) Form New
204804 Line Listings (Multi-site) Form New
204803 LPE Form and Samples ( Multi-Site) Form New
204802 Paper-Based Questionnaire (Pilot and Mult-site) Form New
204801 Web-Based Questionnaire (Pilot and Multi-site) Form New
ICR Details
0920-0960 201211-0920-008
Historical Active
HHS/CDC
Epidemiologic Study of Health Effects Associated with Low Pressure Events in Drinking Water Distribution Systems
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 03/25/2013
Retrieve Notice of Action (NOA) 11/09/2012
Approval is provided for implementation of the pilot study. Approval will only be provided for the full study when CDC submits a nonsubstantive change request to OMB. That change request will detail the results of the pilot study and the protocol changes are necessary as a result of the pilot. CDC should make changes to the protocol between the pilot and the full study to increase response rates if pilot study response is below 60% or there is significant nonresponse bias.
  Inventory as of this Action Requested Previously Approved
03/31/2016 36 Months From Approved
2,291 0 0
585 0 0
0 0 0
Approximately 200 million cases of acute gastrointestinal illness (AGI) occur in the U.S. each year. The Centers for Disease Control and Prevention requests approval for data collection to assess whether individuals exposed to low pressure events in water distribution system are at increased risk for acute gastrointestinal or respiratory illnesses.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  77 FR 17066 03/23/2012
77 FR 65894 10/31/2012
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 2,291 0 0 2,291 0 0
Annual Time Burden (Hours) 585 0 0 585 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new data collection request.
$319,796
Yes Part B of Supporting Statement
No
No
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.
11/09/2012