OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Targeted Surveillance and Biometric Studies for Enhanced Evaluation of CTGs

ICR 201305-0920-002 · OMB 0920-0977 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Adult Targeted Surveillance Survey - screener Form Modified Available
Youth Survey Form Modified Available
Youth Survey Recruitment Screener for Youth Form Removed Available
Youth Activity Diary - completed by youth Form Modified Available
Youth Biometric Measures Form Modified Available
Youth Activity Diary - completed by caregiver Form Modified Available
Caregiver Survey Form Modified Available
Caregiver Survey Recruitment Screener Form Removed Repair queued
Adult Activity Diary Form Modified Available
Adult Biometric Measures Form Modified Repair queued
Adult Targeted Surveillance Survey - Telephone Interview Form Modified Available
Adult Biometric Measures Recruitment Screener (In-person) Form Removed Repair queued
Adult Biometric Measures - screener Form Modified Available
Adult Targeted Surveillance Survey - paper Form Modified Available
0920-12IG_Cover Memo_June 2013 Revision_Final.doc Supplementary Document Uploaded 2013-08-06 Available
0920-12IG Part B_08062013.docx Supporting Statement B Uploaded 2013-08-06 Available
Att 12C_AdultBioMeasures_ItemSources.pdf Supplementary Document Uploaded 2013-04-22 Available
Att 13D-S_AccelReminder_SP.docx Supplementary Document Uploaded 2013-04-22 Repair queued
Att 13D_Accelerometry Reminder.docx Supplementary Document Uploaded 2013-04-22 Available
Att 11F-S_Enhanced_Script_Adults_SP.docx Supplementary Document Uploaded 2013-04-22 Available
Att 11F_Enhanced_Script_Adults.docx Supplementary Document Uploaded 2013-04-22 Repair queued
Att 11E-S_Enhanced_Script_Caregivers(3-11)_SP.docx Supplementary Document Uploaded 2013-04-22 Available
Att 11E_Enhanced_Script_Caregivers(3-11).docx Supplementary Document Uploaded 2013-04-22 Available
Att 11D-S_Enhanced_Script_Youth(12-17)_SP.docx Supplementary Document Uploaded 2013-04-22 Available
Att 11D_Enhanced_Script_Youth(12-17).docx Supplementary Document Uploaded 2013-04-22 Available
Att 11C-S_Enhanced_Script_Parents(12-17)_SP.docx Supplementary Document Uploaded 2013-04-22 Available
Att 11C_Enhanced_Script_Parents(12-17).docx Supplementary Document Uploaded 2013-04-22 Available
Att 11B_ATSS_ReminderPostcard.doc Supplementary Document Uploaded 2013-04-22 Available
Att 11A4-S_Letter_SecondMailing_Paper_SP.docx Supplementary Document Uploaded 2013-08-06 Repair queued
Att 11A4_Letter_SecondMailing_Paper.docx Supplementary Document Uploaded 2013-08-06 Available
Att 11A3-S_Letter_Paper_AfterPhoneAttempt_SP.docx Supplementary Document Uploaded 2013-08-06 Repair queued
Att 11A3_Letter_Paper_AfterPhoneAttempt.docx Supplementary Document Uploaded 2013-08-06 Available
Att 11A-S_LeadLetter_Standard_Phone_SP.docx Supplementary Document Uploaded 2013-08-06 Available
Att 11A2-S_Letter_FirstMailing_Paper_SP.docx Supplementary Document Uploaded 2013-08-06 Repair queued
Att 11A1-S_LeadLetter_Enhanced_SP.docx Supplementary Document Uploaded 2013-08-06 Available
Att 11A1_LeadLetter_Enhanced.docx Supplementary Document Uploaded 2013-08-06 Available
Att 11A2_Letter_FirstMailing_Paper.docx Supplementary Document Uploaded 2013-08-06 Available
Att 11A_LeadLetter_Standard_Phone.docx Supplementary Document Uploaded 2013-08-06 Available
Att 8B-S_Letter_ATSS_Gift_SP.docx Supplementary Document Uploaded 2013-08-06 Available
Att 8B_Letter_ATSS_Gift.docx Supplementary Document Uploaded 2013-08-06 Available
Att 8A-S_ATSS_GiftForm_SP.docx Supplementary Document Uploaded 2013-08-06 Available
Att 8A_ATSS_GiftForm.docx Supplementary Document Uploaded 2013-08-06 Repair queued
Att 6E-S_Enhanced_ParentalPermission_SP.docx Supplementary Document Uploaded 2013-04-18 Available
Att 6E_Enhanced_ParentalPermission.docx Supplementary Document Uploaded 2013-04-18 Available
Att 6D-S_Enhanced_Consent_SP.docx Supplementary Document Uploaded 2013-04-18 Available
Att 6D_Enhanced_Consent.docx Supplementary Document Uploaded 2013-04-18 Available
Att 6C-S_Enhanced_YouthAssent_SP.docx Supplementary Document Uploaded 2013-04-18 Repair queued
Att 6C_Enhanced_YouthAssent.docx Supplementary Document Uploaded 2013-04-18 Available
Att 6B-S_Standard_Consent(Phone)_SP.docx Supplementary Document Uploaded 2013-08-06 Available
Att 6B_Standard_Consent(Phone).docx Supplementary Document Uploaded 2013-08-06 Available
Att 6A-S_Standard_Consent(Paper)_SP.docx Supplementary Document Uploaded 2013-08-06 Repair queued
Att 6A_Standard_Consent(Paper).docx Supplementary Document Uploaded 2013-08-06 Repair queued
Att 5_DataSources.doc Supplementary Document Uploaded 2013-04-18 Available
Att 4C_ListofCTGAwardees.docx Supplementary Document Uploaded 2013-04-18 Available
Att 4B_CTGEvaluationPlan.doc Supplementary Document Uploaded 2013-04-18 Available
Att 4A_StrategicDirections.docx Supplementary Document Uploaded 2013-04-18 Available
Att 3B_IRBApproval_Enhanced.pdf Supplementary Document Uploaded 2013-04-18 Repair queued
Att 3A_IRBApproval_Standard.pdf Supplementary Document Uploaded 2013-04-18 Repair queued
Att 2_60-dayFRN.pdf Supplementary Document Uploaded 2013-04-18 Repair queued
Att 1B_ACASection4201.doc Supplementary Document Uploaded 2013-04-18 Available
Att 1A_PHSA.pdf Supplementary Document Uploaded 2013-04-18 Repair queued
Att 13A-S_AccelInstructions_SP.docx Supplementary Document Uploaded 2013-04-22 Available
Att 13A_AccelInstructions.docx Supplementary Document Uploaded 2013-04-22 Available
Att 13A-S_AccelInstructions_SP.docx Supplementary Document Uploaded 2013-04-22 Repair queued
Att 13A_AccelInstructions.docx Supplementary Document Uploaded 2013-04-22 Available
Att 13A-S_AccelInstructions_SP.docx Supplementary Document Uploaded 2013-04-22 Available
Att 13A_AccelInstructions.docx Supplementary Document Uploaded 2013-04-22 Available
Att 10B-S_EnhancedInvitation_forATSS_Paper_SP.docx Supplementary Document Uploaded 2013-04-22 Available
Att 10B_EnhancedInvitation_forATSS_Paper.docx Supplementary Document Uploaded 2013-04-22 Available
Att 7B-S_ATSS_FAQGuide_SP.doc Supplementary Document Uploaded 2013-04-22 Available
Att 7B_ATSS_FAQGuide.doc Supplementary Document Uploaded 2013-04-22 Available
0920-12IG Part A_08062013.docx Supporting Statement A Uploaded 2013-08-06 Available
IC Document Collections
IC IDCollectionTypeStatusForm
203638 Adult Targeted Surveillance Survey - screener Form Modified
203637 Youth Survey Form Modified
203636 Youth Survey Recruitment Screener for Youth Form Removed
203635 Youth Activity Diary - completed by youth Form Modified
203634 Youth Biometric Measures Form Modified
203633 Youth Activity Diary - completed by caregiver Form Modified
203632 Caregiver Survey Form Modified
203631 Caregiver Survey Recruitment Screener Form Removed
203630 Adult Activity Diary Form Modified
203629 Adult Biometric Measures Form Modified
203628 Adult Targeted Surveillance Survey - Telephone Interview Form Modified
203627 Adult Biometric Measures Recruitment Screener (In-person) Form Removed
203626 Adult Biometric Measures - screener Form Modified
203625 Adult Targeted Surveillance Survey - paper Form Modified
ICR Details
0920-0977 201305-0920-002
Historical Active 201208-0920-003
HHS/CDC 19291
Targeted Surveillance and Biometric Studies for Enhanced Evaluation of CTGs
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 08/16/2013
Retrieve Notice of Action (NOA) 05/07/2013
Approved consistent with the understanding that there are inherent limitations in the design of the evaluations for drawing quantitative conclusions about the effectiveness of different types of programs. It is understood that this study will be used as part of a larger literature about the effectiveness of such interventions. CDC will continue to collaborate with NIH and other federal partners on studies with similar outcomes of interest.
  Inventory as of this Action Requested Previously Approved
08/31/2016 36 Months From Approved
40,164 0 0
11,360 0 0
0 0 0
CDC plans to conduct a study to collect key outcomes required by the ACA in up to 20 selected areas funded through the Community Transformation Grants Program. This is a population-based household assessment of persons 3 years of age and older who live in 20 CTG areas that are implementing interventions. Adults will be asked to complete an Adult Targeted Surveillance Survey as part of a standard protocol. A sample of househoulds from 8 of the areas will be selected to participate in an enhanced protocol that involves an in-home visit to collect biometric measures. All participants will be administered a questionnaire to assess core ACA outcomes.
PL: Pub.L. 111 - 148 4201 Name of Law: Patient Protection and ACA PPHF
   US Code: 42 USC 301 Name of Law: PHSA
  
None
Not associated with rulemaking
  77 FR 23263 04/18/2012
77 FR 47073 08/07/2012
No
11
IC Title Form No. Form Name
Adult Targeted Surveillance Survey - paper none, none Survey Booklet ,   Survey Booklet - Spanish
Adult Targeted Surveillance Survey - screener none, none Adult Targeted Surveillance Survey - telephone screener ,   Adult Targeted Surveillance Survey telephone screener- Spanish
Adult Targeted Surveillance Survey - Telephone Interview none, none Adult Targeted Surveillance Survey - phone interview ,   Adult Targeted Surveillance Survey - phone interview Spanish
Adult Biometric Measures - screener none, none, none, none Adult Biometric Measures Recruitment Screener ,   Adult Biometric Measures Recruitment Screener-Spanish ,   Adult Biometric Measures Recruitment Screener ,   Adult Biometric Measures Recruitment Screener - Spanish
Adult Biometric Measures none, none Adult Biometric Measures ,   Adult Biometric Measures - Spanish
Adult Activity Diary none, none Adult Activity Diary ,   Adult Activity Diary - Spanish
Youth Activity Diary - completed by caregiver none, none Youth Activity Diary ,   Youth Activity Diary - Spanish
Caregiver Survey none, none Caregiver Survey ,   Caregiver Survey - Spanish
Youth Survey none, none Youth Survey ,   Youth Survey - Spanish
Youth Biometric Measures none, none Youth Biometric Measures ,   Youth Biometric Measures - Spanish
Youth Activity Diary - completed by youth none, none Youth Activity Diary ,   Youth Activity Diary - Spanish
Youth Survey Recruitment Screener for Youth none, none Survey Recruitment Screener for Youth ,   Spanish Survey Recruitment Screener for Youth
Caregiver Survey Recruitment Screener none, none Caregiver Screener ,   Spanish Caregiver Screener
Adult Biometric Measures Recruitment Screener (In-person) none, none Biometric Screener in-person ,   Spanish Biometric Screener in-person
  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 40,164 0 0 40,164 0 0
Annual Time Burden (Hours) 11,360 0 0 11,360 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR to support evaluation of ACA activities. Republication of the 30 day waived by OMB as the scope and methodology has not changed from the previous submission.
$5,044,216
Yes Part B of Supporting Statement
Yes
Yes
No
No
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.
04/23/2013