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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 201402-0920-002 · OMB 0920-0955 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
EHDI_PALS_ICR_B_.doc Supporting Statement B Uploaded 2014-01-31 Available
Att 6 UOM E-mail Reminder.docx Supplementary Document Uploaded 2014-01-31 Available
Att 2 60dy FRN.pdf Supplementary Document Uploaded 2014-01-31 Available
Att 1 Legal authority.docx Supplementary Document Uploaded 2014-01-31 Available
Att 5 IRB Determination.pdf Supplementary Document Uploaded 2014-01-31 Available
EHDI_PALS_ICR_A_.doc Supporting Statement A Uploaded 2014-01-31 Available
IC Document Collections
IC IDCollectionTypeStatusForm
205423 EHPI-PALS Facility Survey Other-WWORD Modified
205422 EHDI-PALS Facility Survey Opening Other-WORD Modified
ICR Details
0920-0955 201402-0920-002
Historical Active 201301-0920-005
HHS/CDC 21387
Early Hearing Detection and Intervention - Pediatric Audiology Links to Service (EHDI-PALS) Facility Survey
Revision of a currently approved collection   No
Regular
Approved without change 03/12/2014
Retrieve Notice of Action (NOA) 02/03/2014
  Inventory as of this Action Requested Previously Approved
03/31/2017 36 Months From Approved 03/31/2014
1,200 0 3,500
180 0 258
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 continue 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. 2 additional questions have been included to specifically find out what telepractice system a clinic has in place.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  78 FR 65653 11/01/2013
79 FR 5414 01/31/2014
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 1,200 3,500 0 0 -2,300 0
Annual Time Burden (Hours) 180 258 0 0 -78 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
This is a revised ICR. The survey includes 2 additional questions to specifically find out what telepractice system an audiology clinic has in place. The original ICR estimated that 1500 respondents would complete the survey; 892 actually completed the survey. Of the 892 respondents, it is now estimated that 800 respondents will review their prior answers, 400 will review the purpose statement, and 200 new respondents will complete the revised survey.
$1,938
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.
02/03/2014