Information Collection Request

Salt Sources Study

ICR 201306-0920-001 · OMB 0920-0982 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Study Salt Supplement Questionnaire Form New Available
Follow-Up Urine Collection Questionnaire Form New Available
24-Hour Urine Collection Form New Available
Duplicate Salt Sample Collection Form New Available
Food Record Form Form New Available
Home Tap Water Questionnaire Form New Repair queued
Height and Weight Data Collection Form New Repair queued
Participant Questionnaire Form New Available
Telephone Recruitment and Screening Form and Instruction New Repair queued
Discretionary Salt Use Form New Available
Siconolfietal_PaffenbargerQuestionnaire.pdf Supplementary Document Uploaded 2013-09-04 Available
SaltSourcesStudyPart B_5 20 2013_8_30_2013.doc Supporting Statement B Uploaded 2013-09-04 Available
Att 21_IRB_UMN_consent form_8_28_2013 RM.doc Supplementary Document Uploaded 2013-09-04 Available
Att 20_IRB approval.pdf Supplementary Document Uploaded 2013-06-04 Available
Att 19_Experts Consulted During Salt Sources Development8_28_2013.docx Supplementary Document Uploaded 2013-09-04 Repair queued
Att 18_Salt Sources Study Contractor and Subcontractors.docx Supplementary Document Uploaded 2013-06-04 Repair queued
Att 3_Overview of Protocol.docx Supplementary Document Uploaded 2013-06-04 Available
Att 2B_Summary of Public Comments.docx Supplementary Document Uploaded 2013-06-04 Available
Att 2A_Federal Register Notice.pdf Supplementary Document Uploaded 2013-06-04 Available
Att 1_Authorizing Legislation1.doc Supplementary Document Uploaded 2013-06-04 Available
Att 17C_Study Salt Supplement Record (to be completed by clinic staff).doc Supplementary Document Uploaded 2013-06-04 Available
Att 17D_Study Salt Supplement Procedures for Study Staff.doc Supplementary Document Uploaded 2013-06-04 Available
Att 17B_Study Salt Supplement Intructions for Participants.docx Supplementary Document Uploaded 2013-06-04 Repair queued
Att 16B_Criteria for Redo Collection (Instructions for Study Staff).doc Supplementary Document Uploaded 2013-06-04 Repair queued
Att 15B_How to collect the urine (24 Hour Urine Collection Instructions).docx Supplementary Document Uploaded 2013-06-04 Available
Att 10B_Home Tap Water Collection Procedures for Study Staff.doc Supplementary Document Uploaded 2013-06-04 Available
Att 14B_Duplicate Salt Sample Collection Instructions Sub Study Participants).doc Supplementary Document Uploaded 2013-06-04 Available
Att 13B_Duplicate Salt Sample Instructions (Non Sub Study).doc Supplementary Document Uploaded 2013-06-04 Available
Att 12B_Food Record Instructions.docx Supplementary Document Uploaded 2013-06-04 Repair queued
Att 11B_Food Amounts Booklet.pdf Supplementary Document Uploaded 2013-06-04 Available
Att 4D_Study Fact Sheet.docx Supplementary Document Uploaded 2013-06-04 Available
Att 4C_Cover Letter-Phone Recruits.docx Supplementary Document Uploaded 2013-06-04 Available
Att 4B _Cover Letter-Those who cannot be reached by phone.docx Supplementary Document Uploaded 2013-06-04 Repair queued
Att 4D_Study Fact Sheet.docx Supplementary Document Uploaded 2013-06-04 Available
Att 4C_Cover Letter-Phone Recruits.docx Supplementary Document Uploaded 2013-06-04 Available
Att 4B _Cover Letter-Those who cannot be reached by phone.docx Supplementary Document Uploaded 2013-06-04 Repair queued
SaltSourcesStudyPart A_5 20 2013_8_30_2013.docx Supporting Statement A Uploaded 2013-09-04 Available
IC Document Collections
IC IDCollectionTypeStatusForm
207200 Study Salt Supplement Questionnaire Form New
207199 Follow-Up Urine Collection Questionnaire Form New
207198 24-Hour Urine Collection Form New
207197 Water Collection Instruction New
207196 Duplicate Salt Sample Collection Form New
207195 Food Record Form Form New
207194 24-Hour Dietary Recall Interview Other-24-Hour Dietary Recall Interview-Introduction Script, Scre New
207193 Home Tap Water Questionnaire Form New
207192 Study Orientation Instruction New
207191 Height and Weight Data Collection Form New
207190 Participant Questionnaire Form New
207189 Telephone Recruitment and Screening Form and Instruction New
207188 Discretionary Salt Use Form New
ICR Details
0920-0982 201306-0920-001
Historical Active
HHS/CDC 19730
Salt Sources Study
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 09/06/2013
Retrieve Notice of Action (NOA) 06/05/2013
  Inventory as of this Action Requested Previously Approved
09/30/2015 24 Months From Approved
4,890 0 0
1,372 0 0
0 0 0

CDC plans to conduct a two-year study to obtain current, accurate information about sources of dietary sodium including sodium inherent in foods, sodium in processed and restaurant foods, and salt added to food at the table and during cooking. Information will be collected from diverse groups of adults at three study sites in three distinct geographic regions.

US Code: 42 USC 301 Name of Law: Public Health Service Act-Research and Investigations
  
None

Not associated with rulemaking

  78 FR 14092 03/04/2013
78 FR 33095 06/03/2013
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 4,890 0 0 4,890 0 0
Annual Time Burden (Hours) 1,372 0 0 1,372 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new study supporting HP 2020 objectives and a CDC winnable battle. Existing estimates for sources of dietary sodium are based on data collected > 20 years ago.

$547,000
Yes Part B of Supporting Statement
Yes
No
No
No
Uncollected
Petunia Gissendaner 4046390164

  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.
06/05/2013