OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Improving the Understanding of Traumatic Brain Injury through Policy and Program Evaluation

ICR 201511-0920-011 · OMB 0920-1073 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Parent injury follow-up survey Form Unchanged Available
Athlete injury follow-up survey Form Unchanged Available
Parent weekly surveillance report Form Unchanged Available
Athlete weekly surveillance report Form Unchanged Available
Pre-season parent survey Form Unchanged Available
Pre-season athlete survey Form Unchanged Available
Pre-season coach survey Form Unchanged Available
Change Request_Memo OMB#0920_1073.docx Justification for No Material/Nonsubstantive Change Uploaded 2015-11-20 Available
Crosswalk OMB 11-19-15.xlsx Supplementary Document Uploaded 2015-11-20 Available
SSB_rev_2015-3-23-15 Revised 11-19-15.docx Supporting Statement B Uploaded 2015-11-20 Available
AttachQ_Law and Assoc Policy Character.docx Supplementary Document Uploaded 2015-03-30 Available
AttachP_Notification.docx Supplementary Document Uploaded 2015-03-30 Available
AttachO_Sample Table Shells.docx Supplementary Document Uploaded 2015-03-30 Available
Attachment N Consent forms 3-20.docx Supplementary Document Uploaded 2015-03-30 Available
AttachM - CSR USYSA Agreement.pdf Supplementary Document Uploaded 2015-03-30 Available
AttachL2 NCIPC Research Determination.pdf Supplementary Document Uploaded 2015-03-30 Available
AttachL1 IRB Approved letter Revised.pdf Supplementary Document Uploaded 2015-03-30 Available
AttachL IRB Approved letter.pdf Supplementary Document Uploaded 2015-03-30 Available
AttachK_Invitation letters_3-20.docx Supplementary Document Uploaded 2015-03-30 Available
AttachJ_Flyer_2-25.docx Supplementary Document Uploaded 2015-03-30 Available
AttachB1_Public Comment.docx Supplementary Document Uploaded 2015-03-30 Available
AttachB-60 day published notice_2014-09763.pdf Supplementary Document Uploaded 2015-03-30 Available
AttachA-Authorizing Legislation.docx Supplementary Document Uploaded 2015-03-30 Available
SSA_rev_2015-3-23-15.docx Supporting Statement A Uploaded 2015-03-30 Available
IC Document Collections
IC IDCollectionTypeStatusForm
215899 Parent injury follow-up survey Form Unchanged
215898 Athlete injury follow-up survey Form Unchanged
215897 Parent weekly surveillance report Form Unchanged
215896 Athlete weekly surveillance report Form Unchanged
215895 Pre-season parent survey Form Unchanged
215894 Pre-season athlete survey Form Unchanged
215893 Pre-season coach survey Form Unchanged
ICR Details
0920-1073 201511-0920-011
Historical Active 201503-0920-018
HHS/CDC 16FH
Improving the Understanding of Traumatic Brain Injury through Policy and Program Evaluation
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 12/01/2015
Retrieve Notice of Action (NOA) 11/25/2015
  Inventory as of this Action Requested Previously Approved
06/30/2018 06/30/2018 06/30/2018
35,956 0 35,956
2,452 0 2,452
0 0 0
To determine whether the return-to-play policies followed by club soccer teams make a difference in the proportion of boys and girls ages 14 -18 who return to play with symptoms after a concussion injury, and to assess the relationship between CDC's Heads Up Initiative and concussion knowledge among youth soccer coaches, parents, and athletes. To improve efforts focused on youth athlete concussion prevention, evaluation, and management. The Change Request is for the removal of an endorsement letter from the USYSA. There are no changes to any of the information collection instruments, Burden Hours or Respondents.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  79 FR 24431 04/30/2014
79 FR 59271 10/01/2014
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 35,956 35,956 0 0 0 0
Annual Time Burden (Hours) 2,452 2,452 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
This is a resubmission of a new ICR.
$707,281
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Jeffrey Zirger 404 639-7118 [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.
11/25/2015