Evaluation of Childhood Obesity Prevention and Control Initiative: New York City Healthy Bucks Program

Forms and Documents

Document Name	Status
Neighborhood Resident Survey Form	New
Focus Group with Consumers Form	New
Farmers Market Consumer Survey Form	New
Focus Groups with Farmers Market Vendors Form	New
Farmers Market Vendors Survey Form	New
Farmers Market Managers Survey Form	New
Local Community Organization Survey Form	New
Supporting Statement Part B_12.28.09.doc Supporting Statement B	2010-03-31
Appendix K - Project Consultants.doc Supplementary Document	2010-04-01
Institutional Review Board Notice of Approval_study modification(09).PDF Supplementary Document	2010-04-01
Appendix J IRB Approval_01.21.10.PDF Supplementary Document	2010-04-01
Appendix B - FRN 12.17.09.pdf Supplementary Document	2010-03-31
Appendix A - Authorizing Legislation.doc Supplementary Document	2010-03-31
Appendix H-2 Consumer FG Consent Form_01.21.10.doc Supplementary Document	2010-04-01
Appendix G-2 Consumer Fact Sheet_01.21.10.doc Supplementary Document	2010-04-01
Appendix F-2 Vendor FG Consent Form_01.21.10.doc Supplementary Document	2010-04-01
Appendix E-2 Vendor Fact Sheet_01.21.10.doc Supplementary Document	2010-03-31
Appendix D-2 Manager Fact Sheet_01.21.10.doc Supplementary Document	2010-03-31
Supporting Statement Part A_12.28.09.doc Supporting Statement A	2010-03-31

IC Document Collections

IC ID	Document Title	Status
192695	Neighborhood Resident Survey Form	New
192694	Focus Group with Consumers Form	New
192693	Farmers Market Consumer Survey Form	New
192692	Focus Groups with Farmers Market Vendors Form	New
192691	Farmers Market Vendors Survey Form	New
192690	Farmers Market Managers Survey Form	New
192689	Local Community Organization Survey Form	New

ICR Details

OMB Control No: 0920-0855	ICR Reference No: 201004-0920-009
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluation of Childhood Obesity Prevention and Control Initiative: New York City Healthy Bucks Program
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/12/2010
	Date Received in OIRA: 04/23/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2011	12 Months From Approved
Responses	4,112	0	0
Time Burden (Hours)	660	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: Childhood obesity is a major public health concern. In response to this growing public health crisis, CDC is working to identify promising local programs and policies designed to prevent childhood obesity. Priority is given to programs and policies targeting improved eating habits and physical activity levels among children in low-income communities. The NYC Health Bucks program is one program selected for further evaluation in 2010.

---

Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 66970	12/17/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 16128	03/31/2010
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Farmers Market Consumer Survey	none	Farmers Market Consumer Survey
Focus Group with Consumers	none	Focus Group Guide for Farmers Market Consumers
Neighborhood Resident Survey	none	Neighborhood Resident Survey
Farmers Market Managers Survey	none	Farmers Market Managers Survey
Local Community Organization Survey	none	Local Community Organization Survey
Farmers Market Vendors Survey	none	Farmers Market Vendors Survey
Focus Groups with Farmers Market Vendors	none	Focus Group Guide for Farmers Market Vendors

---

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	4,112	0	0	4,112	0	0
Annual Time Burden (Hours)	660	0	0	660	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 is a new ICR.

---

Annual Cost to Federal Government: $623,804

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

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]? Uncollected

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

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(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: 04/23/2010

---