OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Early Hearing Detection and Intervention - Pediatric Audiology Links to Service (EHDI-PALS) Facility Survey

ICR 201612-0920-011 · OMB 0920-0955 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
EHDI-PALS Survey (review for previous participants) Form and Instruction New Available
EHPI-PALS Facility Survey (first time participants) Form and Instruction Modified Available
EHDI-PALS Facility Survey Introduction (drop-outs) Form and Instruction Modified Available
Att 6_rpt684_IRB_Form2016.pdf Supplementary Document Uploaded 2017-02-15 Available
Att 5 EHDI PALs_Collaborators.docx Supplementary Document Uploaded 2017-02-15 Repair queued
Att 4_Annual reminder to review.docx Supplementary Document Uploaded 2017-02-15 Available
Att 1b Authorizing Legislation_EHDI Act 2010.pdf Supplementary Document Uploaded 2017-02-15 Available
Att 1 Legal authority_PHSA.docx Supplementary Document Uploaded 2017-02-15 Available
EHDIPALS ICR B_2 15 2017.docx Supporting Statement B Uploaded 2017-02-15 Repair queued
EHDIPALS ICR A _2 15 2017.docx Supporting Statement A Uploaded 2017-02-15 Available
IC Document Collections
IC IDCollectionTypeStatusForm
225731 EHDI-PALS Survey (review for previous participants) Form and Instruction New
205423 EHPI-PALS Facility Survey (first time participants) Form and Instruction Modified
205422 EHDI-PALS Facility Survey Introduction (drop-outs) Form and Instruction Modified
ICR Details
0920-0955 201612-0920-011
Historical Active 201402-0920-002
HHS/CDC 12NT
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 05/22/2017
Retrieve Notice of Action (NOA) 02/16/2017
  Inventory as of this Action Requested Previously Approved
05/31/2020 36 Months From Approved 05/31/2017
1,400 0 1,200
64 0 180
2,304 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. In this Revision the method of estimating burden has been refined and the total estimated burden has decreased.
US Code: 42 USC 301 Name of Law: Public Health Service Act
   US Code: 42 USC 280g-1 Name of Law: Early Hearing Detection and Intervention Act of 2010
  
None
Not associated with rulemaking
  81 FR 62138 09/08/2016
82 FR 10773 02/15/2017
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 1,400 1,200 0 200 0 0
Annual Time Burden (Hours) 64 180 0 -116 0 0
Annual Cost Burden (Dollars) 2,304 0 0 2,304 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
The burden per response for a first-time participant is 9 minutes. In subsequent years, burden per response is reduced to 2 minutes, as previous respondents only need to review and update their information. In this Revision ICR, the 2 categories (first-time respondents, and previous respondents) have been disaggregated and separate estimates are provided for each category. The result is a net decrease in total estimated annualized burden hours.
$43,124
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Renita Macaluso 770 488-6458 [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.
02/16/2017