OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Early Hearing Detection and Intervention Hearing Screening and Follow-up survey

ICR 201702-0920-015 · OMB 0920-0733 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Early Hearing Detecton and Intervention Hearing Screening and Follow-up survey Form and Instruction Removed Available
Form CDC EHDI Hearing S Att 4B_CDC EHDI Hearing Screening and Follow-up Survey (HSFS) Form and Instruction New Available
Att 6_Proposed Data Reports.docx Supplementary Document Uploaded 2017-03-09 Available
Att 5_DSHPSHWA Annual Survey2013_screenshots_Rev.pdf Supplementary Document Uploaded 2017-03-09 Available
Att 3_National EHDI Goals.docx Supplementary Document Uploaded 2017-03-08 Available
Att 2_60 Day FRN.pdf Supplementary Document Uploaded 2017-03-08 Available
SupSta B_EHDI.doc Supporting Statement B Uploaded 2017-03-08 Available
Attach_1_2016_B.docx Supplementary Document Uploaded 2017-02-27 Repair queued
SupSta A_EHDI_030817.docm Supporting Statement A Uploaded 2017-03-09 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
43622 Early Hearing Detecton and Intervention Hearing Screening and Follow-up survey Form and Instruction Removed
226006 Att 4B_CDC EHDI Hearing Screening and Follow-up Survey (HSFS) Form and Instruction New
207643 Att 4A)_CDC EHDI (HSFS) Directions Instruction Modified
ICR Details
0920-0733 201702-0920-015
Historical Active 201307-0920-002
HHS/CDC 19917
Early Hearing Detection and Intervention Hearing Screening and Follow-up survey
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 07/19/2017
Retrieve Notice of Action (NOA) 03/10/2017
  Inventory as of this Action Requested Previously Approved
07/31/2020 36 Months From Approved 08/31/2016
116 0 55
238 0 220
0 0 0
This purpose of this data collection is to obtain standardized annual jurisdictional data related to the number of children screened for hearing loss, referred for and receiving follow-up testing, such as diagnostic audiologic evaluation.
PL: Pub.L. 42 - 247 317 Name of Law: Children's Health Act
   PL: Pub.L. 42 - 247 399 Name of Law: Children's Health Act of 2000
   PL: Pub.L. 42 - 241 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  81 FR 69530 10/06/2016
82 FR 11577 02/24/2017
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 116 55 0 61 0 0
Annual Time Burden (Hours) 238 220 0 18 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
The proposed revisions to the HSFS are designed to provide more complete and standardized information about the receipt of recommended EHDI services and the reasons about why some infants are loss to follow-up. Continued use of the HSFS, with the proposed revisions, will ensure that the CDC EHDI team is able to continue monitoring progress towards national EHDI goals, disseminate information to stakeholders, assess progress towards meeting Healthy People 2020 goals related to EHDI, measure progress towards Funding Opportunity Announcement (FOA) objectives, and guide the provision of technical assistance.
$8,890
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.
03/10/2017