OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

[NCIPC] Reporting of the Essentials for Childhood (EfC): Preventing Adverse Childhood Experiences through Data to Action Program

ICR 202507-0920-007 · OMB 0920-1425 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920 Instrument and Protocol Surveillance Capacity Assessment (SCA) Form and Instruction Unchanged Available
Form 0920 Instrument and Protocol Implementation Capacity Assessment (ICA) Form and Instruction Unchanged Missing upstream
Form 0920-1425 Essentials Instrument and Protocol Evaluation and Surveillance Survey - Revised 10JUL2025 Form and Instruction Modified Available
Form 0920 Essentials Instrument and Protocol Evaluation and Surveillance Survey Form and Instruction Modified Available
Form 0920 Essentials Instrument and Protocol Evaluation and Surveillance Survey Form and Instruction Modified Missing upstream
Form 0920 Instrument and Protocol Key Informant Interview - Principal Investigators Form and Instruction Unchanged Available
Form 0920 Instrument and Protocol Surveillance Capacity Assessment (SCA) Form and Instruction Unchanged Repair queued
Form 0920 Instrument and Protocol Key Informant Interview - Principal Investigators Form and Instruction Unchanged Available
Form 0920 Instrument and Protocol Key Informant Interview - Principal Investigators/Implementer Form and Instruction Unchanged Missing upstream
Form 0920 Instrument and Protocol Key Informant Interview - Principal Investigators Form and Instruction Unchanged Available
Form 0920 Instrument and Protocol Key Informant Interview - Principal Investigators Form and Instruction Unchanged Repair queued
Form 0920-1425 Annual Performance Report (APR) Tool - Revised 22JUL2025 Form and Instruction Modified Available
Form 0920- Annual Performance Report (APR) Tool Form and Instruction Modified Available
Form 0920- Annual Performance Report (APR) Tool Form and Instruction Modified Available
Change Request Memo - Essentials for Childhood 072125.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-07-22 Available
Change Request Memo - EO14168 Updates Essentials for Childhood.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-07-10 Repair queued
SSB_EfC_Program_9_14_23.docx Supporting Statement B Uploaded 2023-10-25 Available
SSB_EfC_Program_9_14_23.docx Supporting Statement B Uploaded 2023-10-25 Available
SSA_EfC Program_050125 EO clean.docx Supporting Statement A Uploaded 2025-07-10 Available
SSA_EfC Program_050125 EO clean.docx Supporting Statement A Uploaded 2025-07-10 Available
Att. 8 Research Determination.pdf Supplementary Document Uploaded 2023-10-12 Available
Att. 8 Research Determination.pdf Supplementary Document Uploaded 2023-10-12 Repair queued
Att. 7 EfC-ICR-PII-Privacy Act-Determination.pdf Supplementary Document Uploaded 2023-10-12 Available
Att. 7 EfC-ICR-PII-Privacy Act-Determination.pdf Supplementary Document Uploaded 2023-10-12 Repair queued
Att. 1_PHSA_301a_USC_241a and Section 393USC 280b-1a.pdf Supplementary Document Uploaded 2023-10-12 Available
Att. 1_PHSA_301a_USC_241a and Section 393USC 280b-1a.pdf Supplementary Document Uploaded 2023-10-12 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
262779 Instrument and Protocol Implementation Capacity Assessment (ICA) Form and Instruction UnchangedInstrument and Protocol Surveillance Capacity Assessment (SCA)
262779 Instrument and Protocol Implementation Capacity Assessment (ICA) Form and Instruction Unchanged
262777 Essentials Instrument and Protocol Evaluation and Surveillance Survey Form and Instruction ModifiedEssentials Instrument and Protocol Evaluation and Surveillance Survey - Revised 10JUL2025
262777 Essentials Instrument and Protocol Evaluation and Surveillance Survey Form and Instruction ModifiedEssentials Instrument and Protocol Evaluation and Surveillance Survey
262777 Essentials Instrument and Protocol Evaluation and Surveillance Survey Form and Instruction Modified
262776 Instrument and Protocol Surveillance Capacity Assessment (SCA) Form and Instruction UnchangedInstrument and Protocol Key Informant Interview - Principal Investigators
262776 Instrument and Protocol Surveillance Capacity Assessment (SCA) Form and Instruction Unchanged
262775 Instrument and Protocol Key Informant Interview - Principal Investigators/Implementer Form and Instruction UnchangedInstrument and Protocol Key Informant Interview - Principal Investigators
262775 Instrument and Protocol Key Informant Interview - Principal Investigators/Implementer Form and Instruction Unchanged
262773 Instrument and Protocol Key Informant Interview - Principal Investigators Form and Instruction UnchangedInstrument and Protocol Key Informant Interview - Principal Investigators
262773 Instrument and Protocol Key Informant Interview - Principal Investigators Form and Instruction Unchanged
262771 Annual Performance Report (APR) Tool Form and Instruction ModifiedAnnual Performance Report (APR) Tool - Revised 22JUL2025
262771 Annual Performance Report (APR) Tool Form and Instruction ModifiedAnnual Performance Report (APR) Tool
262771 Annual Performance Report (APR) Tool Form and Instruction Modified
ICR Details
0920-1425 202507-0920-007
Active 202310-0920-004
HHS/CDC 0920-1425-25-0135
[NCIPC] Reporting of the Essentials for Childhood (EfC): Preventing Adverse Childhood Experiences through Data to Action Program
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved with change 07/22/2025
Retrieve Notice of Action (NOA) 07/10/2025
  Inventory as of this Action Requested Previously Approved
12/31/2026 12/31/2026 12/31/2026
72 0 72
168 0 168
0 0 0
The goal of this ICR is to collect data to monitor project performance from grantees funded under Essentials for Childhood (EfC): Preventing Adverse Childhood Experiences through Data to Action. Information collected from recipients will be used to monitor and evaluate progress of program goals and objectives, identify technical assistance needs, and be accountable for the funding by responding to requests for information about the cooperative agreement. The population studied will include 100% of EfC-funded recipients. Therefore, a sampling method is not required. Recipients will report performance data to CDC annually using a web-based system (i.e., Partners’ Portal). No research design or human subjects involved. Information will be also collected via virtual interview sessions. Quantitative data will be analyzed using descriptive and summary statistics. Qualitative data will be analyzed through thematic analysis to define priority area topics and emerging themes. This Non-Substantive Change Request is submitted for compliance with recently issued EOs 14168 and 14151. There is no anticipated change to the approved burden.
US Code: 42 USC 301(a) 241a Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  88 FR 19308 03/31/2023
88 FR 75591 11/03/2023
Yes
  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 72 72 0 0 0 0
Annual Time Burden (Hours) 168 168 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$53,895
Yes Part B of Supporting Statement
    No
    No
No
No
No
No
Kennya Burroughs 404 639-4766 [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.
07/10/2025