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Federal forms, ICRs, and supporting documents

Information Collection Request

Early Hearing Detection and Intervention - Pediatric Audiology Links to Service (EHDI-PALS) Facility Survey

ICR 201301-0920-005 · OMB 0920-0955 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
EHDI_PALS_ICR_B (3).doc Supporting Statement B Uploaded 2013-01-07 Available
Att A Legal authority.docx Supplementary Document Uploaded 2013-01-07 Available
EHDI_PALS_ICR_A_(3).doc Supporting Statement A Uploaded 2013-01-07 Available
IC Document Collections
IC IDCollectionTypeStatusForm
205423 EHPI-PALS Facility Survey Other-SCREENSHOT New
205422 EHDI-PALS Facility Survey Opening Other-WORD New
ICR Details
0920-0955 201301-0920-005
Historical Active
HHS/CDC
Early Hearing Detection and Intervention - Pediatric Audiology Links to Service (EHDI-PALS) Facility Survey
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 02/18/2013
Retrieve Notice of Action (NOA) 01/15/2013
  Inventory as of this Action Requested Previously Approved
02/28/2014 12 Months From Approved
3,500 0 0
258 0 0
0 0 0
NCBDDD will collect data from pediatric audiologists who provide services to children age 5 and younger. The overall purpose of this study is to identify and quantify the audiology facility resources in the U.S. Facility data will be compiled into a distribution map for CDC-EHDI team and state EHDI coordinators to visualize the geographic distribution of infants who are lost to follow up in relationship to the pediatric audiology clinic distribution. Since April 2010, the EHDI-PALS workgroup has sought consensus on the loss to follow up/loss to documentation issues facing EHDI programs.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  77 FR 37050 06/20/2012
77 FR 76492 12/28/2012
Yes
2
IC Title Form No. Form Name
EHDI-PALS Facility Survey Opening
EHPI-PALS Facility Survey
  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 3,500 0 0 3,500 0 0
Annual Time Burden (Hours) 258 0 0 258 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a NEW collection request for a new OMB Control Number
$1,835
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Thelma Sims 4046394771
  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.
01/15/2013