OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Program Evaluation of CDC’s Core State Injury Prevention Program

ICR 202110-0920-010 · OMB 0920-1365 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-21GB Special Emphasis Reports Form and Instruction New Repair queued
Form 0920-21GB Hospital Discharge Injury Indicators Form and Instruction New Missing upstream
Form 0920-21GB Emergency Department Injury Indicators Form and Instruction New Repair queued
Form 0920-21GB Injury Indicators Form and Instruction New Repair queued
Form 0920-21GB Recipient-level Group Interviews Form and Instruction New Repair queued
Form 0920-21GB Economic Indicators Form and Instruction New Repair queued
Form 0920-21GB Implementation Capacity Rubric Form and Instruction New Repair queued
Attachment L_Partnes Portal Screen Shoots.pptx Supplementary Document Uploaded 2021-10-27 Repair queued
Attachment D_Privacy Act Applicability CORE SIPP.pdf Supplementary Document Uploaded 2021-10-27 Repair queued
Attachment C_Research STARSDetermination10.25.21.pdf Supplementary Document Uploaded 2021-10-27 Repair queued
Attachment B_60 Dy FRN CoreSIPP_Evaluation.pdf Supplementary Document Uploaded 2021-10-27 Repair queued
Attachment A_Authorizing_Legislation.docx Supplementary Document Uploaded 2021-10-27 Repair queued
ICR - SSB_CoreSIPP_ProgramEval_2021_final.docx Supporting Statement B Uploaded 2021-10-27 Missing upstream
ICR - SSA_CoreSIPP_ProgramEval_final.docx Supporting Statement A Uploaded 2021-10-29 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
249953 Special Emphasis Reports Form and Instruction New
249952 Hospital Discharge Injury Indicators Form and Instruction New
249951 Emergency Department Injury Indicators Form and Instruction New
249950 Injury Indicators Form and Instruction New
249948 Recipient-level Group Interviews Form and Instruction New
249947 Economic Indicators Form and Instruction New
249946 Implementation Capacity Rubric Form and Instruction New
ICR Details
202110-0920-010
Received in OIRA
HHS/CDC 0920-21GB
Program Evaluation of CDC’s Core State Injury Prevention Program
New collection (Request for a new OMB Control Number)   No
Regular 10/29/2021
  Requested Previously Approved
36 Months From Approved
161 0
679 0
0 0
This program evaluation is intended to assess both recipient-level and program-level outcomes associated with the NCIPC's Core SIPP funded state injury prevention program. Evaluation metrics will assess injury prevention-focused infrastructure development, surveillance system development and use, and partnerships.
US Code: 42 USC 241 Name of Law: PHSA
  
None
Not associated with rulemaking
  86 FR 30939 06/10/2021
86 FR 60042 10/29/2021
Yes
  Total Request 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 161 0 0 161 0 0
Annual Time Burden (Hours) 679 0 0 679 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a New collection
$242,723
No
    No
    No
No
No
No
No
Kevin Joyce 404 639-1944 [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.
10/29/2021