OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Assessment of Outcomes Associated with the Preventive Health and Health Services Block Grant

ICR 201901-0920-003 · OMB 0920-1257 · Active

Forms and Documents
DocumentTypeStatusAvailability
Thirdparty_sitesecuritysurveyplan_Qualtrics_PHHS Block Grant Assessment.pdf Supplementary Document Uploaded 2019-01-17 Available
CDC_PRA_Determination_PHHS Block Grant Assessment.pdf Supplementary Document Uploaded 2019-01-17 Available
Attachment H - Non-Research Determination.pdf Supplementary Document Uploaded 2019-01-17 Available
Attachment G - Privacy Impact Assessment.pdf Supplementary Document Uploaded 2019-01-17 Available
Attachment C - PHHS Block Grant Measurement Framework Version 1.5.pdf Supplementary Document Uploaded 2019-01-17 Available
Attachment B - Authorizing Legislation Public Health Service Act _42 U.....pdf Supplementary Document Uploaded 2019-01-17 Available
Attachment A- List of PHHS Block Grant Grantees.docx Supplementary Document Uploaded 2019-01-17 Available
SSB_PHHS Block Grant Assessment_.docx Supporting Statement B Uploaded 2019-01-17 Available
SSA _PHHS Block Grant Assessment _revised_3.27.19.docx Supporting Statement A Uploaded 2019-03-29 Available
IC Document Collections
IC IDCollectionTypeStatusForm
234732 Preventive Health and Health Services Block Grant Assessment Other-WORD New
ICR Details
0920-1257 201901-0920-003
Active
HHS/CDC 0920-18AVU
Assessment of Outcomes Associated with the Preventive Health and Health Services Block Grant
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 04/02/2019
Retrieve Notice of Action (NOA) 02/08/2019
OMB is approving this information collection request for a period of three years during which time CDC will request approval to extend or revise the collection if CDC seeks to continue the information collection activity beyond the period or in the manner approved under this action.
  Inventory as of this Action Requested Previously Approved
04/30/2022 36 Months From Approved
61 0 0
46 0 0
0 0 0
This data collection will assess select cross-cutting outputs and outcomes of the PHHS Block Grant and demonstrates the utility of the grant on a national level. Respondents include the 61 Block Grant grantees. Data will be collected using a web-based data collection instrument in fall 2019.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  83 FR 45246 09/06/2018
84 FR 2522 02/07/2019
No
1
IC Title Form No. Form Name
Preventive Health and Health Services Block Grant Assessment 0920-XXXX Preventive Health and Health Services Block Grant Assessment
  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 61 0 0 61 0 0
Annual Time Burden (Hours) 46 0 0 46 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a NEW collection request for a new OMB Control Number.
$25,394
Yes Part B of Supporting Statement
    No
    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.
02/08/2019