OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

National Evaluation of the DP18-1815 Cooperative Agreement Program: Category B, Cardiovascular Disease Prevention and Management

ICR 202110-0920-012 · OMB 0920-1311 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Cost Study Resource Use and Cost Inventory Tool – Partner/Site Level Form and Instruction Unchanged Missing upstream
CCL Partner Site-Level Informant Interview Form and Instruction Unchanged Available
MTM Partner Site-Level Interview Form and Instruction Unchanged Repair queued
TBC Partner Site-Level Interview Form and Instruction Unchanged Missing upstream
CQM Partner Site-Level Interview Form and Instruction Unchanged Repair queued
Recipient-Led Evaluation Annual Report Template Form and Instruction Unchanged Missing upstream
Cost Study Resource Use and Cost Study Inventory Tool - Health Departments Form and Instruction Unchanged Missing upstream
CCL Group Discussion Form and Instruction Unchanged Missing upstream
CCL Health Department Interview Form and Instruction Unchanged Repair queued
TBC Group Discussion Form and Instruction Unchanged Repair queued
MTM Health Department Interview Form and Instruction Unchanged Repair queued
TBC Health Department Interview Form and Instruction Unchanged Repair queued
CQM Group Discussion Form and Instruction Unchanged Repair queued
CQM Health Department Interview Form and Instruction Unchanged Missing upstream
SSA_1815 Category B_National Evaluation_v06_10-11-21.docx Justification for No Material/Nonsubstantive Change Uploaded 2021-10-27 Missing upstream
Att 9e. Cat B Case Study Follow Up Email.docx Supplementary Document Uploaded 2020-05-05 Repair queued
Att 9d. Cat B Case Study Rem Email.docx Supplementary Document Uploaded 2020-05-05 Repair queued
Att 9c. Cat B Case Study Confirm Email.docx Supplementary Document Uploaded 2020-05-05 Repair queued
Att 9b. Cat B Case Study Partner Site Invite.docx Supplementary Document Uploaded 2020-05-05 Repair queued
Att 9a. Cat B Case Study HD Invite_rev.docx Supplementary Document Uploaded 2020-12-02 Repair queued
Att 8b. Inst Rev Board App Not_Exemp Det_Pt B.PDF Supplementary Document Uploaded 2020-05-05 Repair queued
Att 8a. Inst Rev Board App Not_Exemp Det_Pt A.pdf Supplementary Document Uploaded 2020-05-05 Repair queued
Att 7. 60-day FRN.pdf Supplementary Document Uploaded 2020-05-05 Repair queued
Att 3f. Cat B 1815 Eval Gantt Chart.xlsx Supplementary Document Uploaded 2020-05-05 Repair queued
Att 3e. Cat B 1815 Summ of Annual Resp.docx Supplementary Document Uploaded 2020-05-05 Repair queued
Att 3d. Cat B Crosswalk Eval Comp_Data Coll Tools.docx Supplementary Document Uploaded 2020-05-05 Repair queued
Att 3c. 1815 Logic Model.docx Supplementary Document Uploaded 2020-05-05 Repair queued
Att 3b. 1815 Strat Prev_Control.docx Supplementary Document Uploaded 2020-05-05 Missing upstream
Att 3a. 1815 List of HD Awardees.docx Supplementary Document Uploaded 2020-05-05 Repair queued
Att 2. Auth Leg Sec 301a of PH Serv Act.pdf Supplementary Document Uploaded 2020-05-05 Repair queued
Att 1. CDC-RFA-DP18-1815PPHF18.pdf Supplementary Document Uploaded 2020-05-05 Repair queued
SSB_1815 Category B_v06_rev.docx Supporting Statement B Uploaded 2020-12-02 Missing upstream
SSA_1815 Category B_v06_rev.docx Supporting Statement A Uploaded 2020-12-02 Missing upstream
IC Document Collections
IC IDCollectionTypeStatusForm
241440 Cost Study Resource Use and Cost Inventory Tool – Partner/Site Level Form and Instruction Unchanged
241439 CCL Partner Site-Level Informant Interview Form and Instruction Unchanged
241438 MTM Partner Site-Level Interview Form and Instruction Unchanged
241436 TBC Partner Site-Level Interview Form and Instruction Unchanged
241435 CQM Partner Site-Level Interview Form and Instruction Unchanged
241434 Recipient-Led Evaluation Annual Report Template Form and Instruction Unchanged
241433 Cost Study Resource Use and Cost Study Inventory Tool - Health Departments Form and Instruction Unchanged
241432 CCL Group Discussion Form and Instruction Unchanged
241431 CCL Health Department Interview Form and Instruction Unchanged
241430 TBC Group Discussion Form and Instruction Unchanged
241428 MTM Health Department Interview Form and Instruction Unchanged
241426 TBC Health Department Interview Form and Instruction Unchanged
241425 CQM Group Discussion Form and Instruction Unchanged
241424 CQM Health Department Interview Form and Instruction Unchanged
ICR Details
0920-1311 202110-0920-012
Received in OIRA 202003-0920-010
HHS/CDC 0920-1311-22AG
National Evaluation of the DP18-1815 Cooperative Agreement Program: Category B, Cardiovascular Disease Prevention and Management
No material or nonsubstantive change to a currently approved collection   No
Regular 10/27/2021
  Requested Previously Approved
12/31/2023 12/31/2023
253 253
743 743
30,515 30,515
This change request is requesting that HD-Level Recipient Interviews and Partner Site-Level Interviews be modified in order to schedule small group discussions in addition to one-on-one interviews with the same intended interviewee group when scheduling allows. This would offer group discussions as an option to the health department recipients and their healthcare partners, promoting richer discussion and reducing the number of total overall data collection events without increasing the overall burden hours. The attached supporting document (SSA) highlights the changes requested can be found on pp. 12, 13 and 16.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  84 FR 32185 07/05/2019
85 FR 29451 05/15/2020
No
  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 253 253 0 0 0 0
Annual Time Burden (Hours) 743 743 0 0 0 0
Annual Cost Burden (Dollars) 30,515 30,515 0 0 0 0
No
No
This is a new information collection request.
$1,041,626
Yes Part B of Supporting Statement
    Yes
    No
No
No
No
No
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.
10/27/2021