OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

National Survey of Community-based Policy and Environmental Supports for Healthy Eating and Active Living

ICR 201312-0920-003 · OMB 0920-1007 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Telephone Follow-up Form New Available
Survey Form New Available
Part B CBS Natl Survey_12 04 2013.docx Supporting Statement B Uploaded 2013-12-04 Available
Appendix E Example_Tables_10 25 2013.docx Supplementary Document Uploaded 2013-11-21 Available
Appendix B2 Summary of Public Comments.doc Supplementary Document Uploaded 2013-11-21 Available
Appendix B1 FRN 06 03 2013.pdf Supplementary Document Uploaded 2013-11-21 Available
Appendix A Supporting_Legislation_9 16 2013.doc Supplementary Document Uploaded 2013-11-21 Available
Appendix D5 Email Non Response Follow Up_12042013.doc Supplementary Document Uploaded 2013-12-04 Available
Appendix D3 Instructions for Accessing the Web Survey_12032013.docx Supplementary Document Uploaded 2013-12-04 Available
Appendix D2 Study Fact Sheet_12032013.docx Supplementary Document Uploaded 2013-12-04 Repair queued
Appendix D1 Study_Invitation_Letter_10 28 2013.docx Supplementary Document Uploaded 2013-12-04 Available
Part A CBS Natl Survey_12 04 2013.docx Supporting Statement A Uploaded 2013-12-04 Available
IC Document Collections
IC IDCollectionTypeStatusForm
209575 Telephone Follow-up Form New
209574 Survey Form New
ICR Details
0920-1007 201312-0920-003
Historical Active
HHS/CDC 20997
National Survey of Community-based Policy and Environmental Supports for Healthy Eating and Active Living
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 01/02/2014
Retrieve Notice of Action (NOA) 12/05/2013
  Inventory as of this Action Requested Previously Approved
01/31/2015 12 Months From Approved
25,559 0 0
3,438 0 0
0 0 0
CDC plans to conduct a survey to assess local governments' policies and practices that support health eating and active living among their residents.
US Code: 42 USC 301 Name of Law: PHSA
  
None
Not associated with rulemaking
  78 FR 33094 06/03/2013
78 FR 70563 11/26/2013
Yes
2
IC Title Form No. Form Name
Survey none, none Survey - screenshots ,   Survey - Word
Telephone Follow-up none Non-response Follow-up
  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 25,559 0 0 25,559 0 0
Annual Time Burden (Hours) 3,438 0 0 3,438 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR.
$534,357
Yes Part B of Supporting Statement
Yes
No
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.
12/05/2013