OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Early Hearing Detection and Intervention Hearing Screening and Follow-up survey

ICR 201307-0920-002 · OMB 0920-0733 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Early Hearing Detecton and Intervention Hearing Screening and Follow-up survey Form and Instruction Modified Available
Supp_Statement_B_ EHDI_OMB_2013_Renewal_Draft - Clean.doc Supporting Statement B Uploaded 2013-07-02 Available
Attach_2_60day_FRN.pdf Supplementary Document Uploaded 2013-07-02 Available
Attach_14_2013_NonResEmail.docx Supplementary Document Uploaded 2013-07-02 Available
Attach_13_2013_reminder.docx Supplementary Document Uploaded 2013-07-02 Available
Attach_12_2013_invite.docx Supplementary Document Uploaded 2013-07-02 Available
Attach_11_2013_UnclearResEmail.docx Supplementary Document Uploaded 2013-07-02 Repair queued
Attach_10_2013_DataRpts.docx Supplementary Document Uploaded 2013-07-02 Available
Attach_9_2013_ResDet.docx Supplementary Document Uploaded 2013-07-02 Available
Attach_8_2013_ENT.docx Supplementary Document Uploaded 2013-07-02 Available
Attach_7_2013_CO_LOS.docx Supplementary Document Uploaded 2013-07-02 Repair queued
Attach_6_2013_LOS.docx Supplementary Document Uploaded 2013-07-02 Available
Attach_5_2013.docx Supplementary Document Uploaded 2013-07-02 Available
Attach_3_2013_Goals.docx Supplementary Document Uploaded 2013-07-02 Available
Attach_1_2013_Laws.docx Supplementary Document Uploaded 2013-07-02 Available
Supp_Statement_A_EHDI_OMB_2013_(06212013).docm Supporting Statement A Uploaded 2013-07-02 Available
IC Document Collections
IC IDCollectionTypeStatusForm
43622 Early Hearing Detecton and Intervention Hearing Screening and Follow-up survey Form and Instruction Modified
207643 Survey Directions Instruction New
192922 CDC EHDI Hearing Screening and Followup Survey (HSFS) Instruction Removed
ICR Details
0920-0733 201307-0920-002
Historical Active 201005-0920-004
HHS/CDC 19917
Early Hearing Detection and Intervention Hearing Screening and Follow-up survey
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 08/14/2013
Retrieve Notice of Action (NOA) 07/03/2013
  Inventory as of this Action Requested Previously Approved
08/31/2016 36 Months From Approved
114 0 0
230 0 0
0 0 0
This data collection is intended to target only state and territorial EHDI program directors. NCBDDD will utilize a revised survey to collect standardized annual state data related to the number of children screened for hearing loss, referred for and receiving follow-up testing (e.g., diagnostic audiologic evaluation).
PL: Pub.L. 42 - 241 301 Name of Law: Public Health Service Act
   PL: Pub.L. 42 - 247 317 Name of Law: Children's Health Act
   PL: Pub.L. 42 - 247 399 Name of Law: Children's Health Act of 2000
  
None
Not associated with rulemaking
  78 FR 18986 03/28/2013
78 FR 39295 07/01/2013
No
  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 114 0 0 114 0 0
Annual Time Burden (Hours) 230 0 0 230 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a reinstatement with change ICR. Minor change to burden due to changes which include changing the order of some questions, splitting the previously combined question about the number of infants that were non-residents or moved out jurisdiction into two separate questions and adding new questions. These include questions asked about how many infants were in a neonatal intensive care unit (NICU) for more than 5 days, transferred without any documentation of a hearing screening, unable to be screened or receive diagnostic testing due to a medical reason, number of cases where a primary care physician did not refer an infant for diagnostic testing, and cases of permanent hearing loss among non-resident infants. Complete discussion of changes are found in SSA.15, page 15-17.
$5,475
Yes Part B of Supporting Statement
No
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.
07/03/2013