Program Evaluation of CDC’s Core State Injury Prevention Program

OMB Control No: 0920-1365	ICR Reference No: 202506-0920-006
Status: Active	Previous ICR Reference No: 202110-0920-010
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1365
Title: Program Evaluation of CDC’s Core State Injury Prevention Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/21/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/16/2025
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2028	36 Months From Approved	07/31/2025
Responses	179	0	161
Time Burden (Hours)	764	0	679
Cost Burden (Dollars)	0	0	0

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Abstract: 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. This revision request is to add three recipients to the data collection. The estimated change in burden from the last OMB approval is an increase of 109 hours.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 77160	09/20/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 24624	06/11/2025
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 7

IC Title Form No. Form Name Economic Indicators 0920-1365 EcoIndicatorCostTool_CoreSIPP Emergency Department Injury Indicators 0920-1365 ERDEPTInjuryIndicator_CoreSIPP Hospital Discharge Injury Indicators 0920-1365 HosDischargeInjuryIndicator_CoreSIPP Implementation Capacity Rubric 0920-1365 ImplementCapRubric_CoreSIPP Injury Indicators 0920-1365 DeathInjuryIndicator_CoreSIPP Recipient-level Group Interviews 0920-1365 RECGroupInterview_CoreSIPP Special Emphasis Reports 0920-21GB, 0920-1365 Special Emphasis Report Examples ,   SpecialEmphasisRpt_CoreSIPP

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ICR Summary of Burden

	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	179	161	0	18	0	0
Annual Time Burden (Hours)	764	679	0	85	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This revision request is to add three recipients to the data collection. The estimated change in burden from the last OMB approval is an increase of 109 hours

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Annual Cost to Federal Government: $242,723

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Odion Clunis 770 488-0045 [email protected]

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Common Form ICR:  No

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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:
		(a) It is necessary for the proper performance of agency functions;
		(b) It avoids unnecessary duplication;
		(c) It reduces burden on small entities;
		(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
		(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
		(f) It indicates the retention periods for recordkeeping requirements;
		(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
			(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;
		(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
		(i) It uses effective and efficient statistical survey methodology (if applicable); and
		(j) It makes appropriate use of information technology.
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.
Certification Date: 06/16/2025

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