OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Monitoring and Reporting System for the Division of Community Health's Cooperative Agreement Programs

ICR 201612-0920-001 · OMB 0920-1053 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Private Sector - Special Data Request Form Unchanged Available
Private Sector - Semi-annual Reporting Form Unchanged Available
Private Sector - Initial population Form Unchanged Available
State/Local/Tribal Sector - Special Data Reporting Form Unchanged Available
State/Local/Tribal - Semi-annual reporting Form Unchanged Repair queued
State/Local/Tribal Sector-Initial population Form Unchanged Available
Att3a_DCH-PMD Screen Shots_11 03 16.docx Supplementary Document Uploaded 2016-12-01 Repair queued
Att3b_DCH-PMD _User Guide_11 03 2016.docx Supplementary Document Uploaded 2016-12-01 Repair queued
OMB CHANGE REQUEST 11 09 2016.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-12-01 Available
Att3b_DCH-PMD _User Guide_03 10 2016.docx Supplementary Document Uploaded 2016-03-15 Available
OMB CHANGE REQUEST 03 14 2016.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-03-15 Available
SS Part B_03 06 2015.docx Supporting Statement B Uploaded 2015-03-10 Available
SS Part A_03 06 2015.docx Supporting Statement A Uploaded 2015-03-10 Available
Att 5_Federal Register Notice.pdf Supplementary Document Uploaded 2015-01-12 Available
Att 2_List of Awardees.docx Supplementary Document Uploaded 2015-01-12 Available
Att 1b_ACA PPHF.pdf Supplementary Document Uploaded 2015-01-12 Available
Att 1a_PHSA.pdf Supplementary Document Uploaded 2015-01-12 Available
IC Document Collections
IC IDCollectionTypeStatusForm
214570 Private Sector - Special Data Request Form Unchanged
214569 Private Sector - Semi-annual Reporting Form Unchanged
214568 Private Sector - Initial population Form Unchanged
214567 State/Local/Tribal Sector - Special Data Reporting Form Unchanged
214566 State/Local/Tribal - Semi-annual reporting Form Unchanged
214565 State/Local/Tribal Sector-Initial population Form Unchanged
ICR Details
0920-1053 201612-0920-001
Historical Active 201603-0920-006
HHS/CDC 17EE
Monitoring and Reporting System for the Division of Community Health's Cooperative Agreement Programs
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 12/05/2016
Retrieve Notice of Action (NOA) 12/05/2016
Previous terms continue: Non-substantive change requests will be approved only if the following conditions are met: the data requested is readily available to the awardee, the collection is low burden to the awardee (less than 30 minutes to compile and report the information), and it is related to existing data collected from awardees.
  Inventory as of this Action Requested Previously Approved
03/31/2018 03/31/2018 03/31/2018
311 0 311
1,596 0 1,596
0 0 0
CDC DCH is proposing a minor Change, effective immediately, to facilitate awardees reporting critical information in a consistent manner. Specifically, CDC DCH Requests to replace one Screen and its accompanying user guidance in the DCH-PMD with a new Screen and accompanying guidance. The new screen will allow awardees to more thoroughly and reliably report evaluation outcomes. There are no requested changes to the number of respondents, the overall purpose of the information collection, nor the estimated burden per response.
US Code: 42 USC 241 Name of Law: PHSA
   PL: Pub.L. 111 - 148 4002 Name of Law: Patient Protection and Affordable Care Act
  
None
Not associated with rulemaking
  79 FR 41691 07/17/2014
80 FR 1636 01/13/2015
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 311 311 0 0 0 0
Annual Time Burden (Hours) 1,596 1,596 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$178,864
Yes Part B of Supporting Statement
No
Yes
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.
12/05/2016