Formative Research for and Community Uptake of the Eagle Books and Youth Books for American Indians and Alaska Natives

Forms and Documents

Document Name	Status
Interview with Middle Schoolers Form	New
Interview with Children Grades 2-4 Form	New
Interview with Children K-1 Form	New
Interview with Parents Form	New
Interview with Teachers Form	New
Interview with School Administrators Form	New
Interview with Community Representatives Form	New
Local Scheduling Worksheet Form	New
SS Part B July 18 2011.doc Supporting Statement B	2011-07-20
L Eagle Books Observation List.docx Supplementary Document	2011-07-20
J IRB Approval rpt684_IRB_Form.pdf Supplementary Document	2011-07-20
Att B-2. Summary of Public Comments.doc Supplementary Document	2011-07-20
B-1 60-day FRN 02.11.2011.pdf Supplementary Document	2011-07-20
A-2 Authorizing Legislation WIC.pdf Supplementary Document	2011-07-20
A-1 Authorizing Legislation PHSA.pdf Supplementary Document	2011-07-20
I-4 Middle Schooler Youth Assent Form.doc Supplementary Document	2011-07-20
I-3 Middle Schooler Parental Consent.doc Supplementary Document	2011-07-20
I-2 Middle Schoolers Parent Information Sheet.doc Supplementary Document	2011-07-20
H-3 Children Grades K-4 Youth Assent Form.doc Supplementary Document	2011-07-20
H-2 Children Grades K-4 Parental Consent Form.doc Supplementary Document	2011-07-20
G-3 Children Grades K-4 Youth Assent Form.doc Supplementary Document	2011-07-20
G-2 Children Grades K-4 Parental Consent Form.doc Supplementary Document	2011-07-20
F-3 Parents Consent form.doc Supplementary Document	2011-07-20
F-2 Parents Information Sheet.doc Supplementary Document	2011-07-20
E-3 Teachers Consent Form.doc Supplementary Document	2011-07-20
E-2 Teachers Information Sheet.doc Supplementary Document	2011-07-20
D-3 School Admin Consent Form.doc Supplementary Document	2011-07-20
D-2 School Admin Information Sheet.doc Supplementary Document	2011-07-20
C-2 Comm Rep Information Sheet.doc Supplementary Document	2011-07-20
C-3 Comm Rep Consent Form.doc Supplementary Document	2011-07-20
SS Part A July 19 2011.doc Supporting Statement A	2011-07-20

IC Document Collections

IC ID	Document Title	Status
198630	Interview with Middle Schoolers Form	New
198629	Interview with Children Grades 2-4 Form	New
198628	Interview with Children K-1 Form	New
198627	Interview with Parents Form	New
198626	Interview with Teachers Form	New
198625	Interview with School Administrators Form	New
198624	Interview with Community Representatives Form	New
198623	Local Scheduling Worksheet Form	New

ICR Details

OMB Control No: 0920-0897	ICR Reference No: 201107-0920-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Formative Research for and Community Uptake of the Eagle Books and Youth Books for American Indians and Alaska Natives
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 without change	Conclusion Date: 08/12/2011
	Date Received in OIRA: 07/25/2011
Terms of Clearance: Approved consistent with the understanding that the collection is not intended to be an "impact" (outcome) evaluation of changes attributable to the books. Rather, this is a formative researach study.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2013	24 Months From Approved
Responses	108	0	0
Time Burden (Hours)	112	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC's Native Diabetes Wellness Program requests OMB approval to conduct formative research to assess uptake of, receptivity, satisfaction with, and influence of the Eagle Books and Youth Eagle Books.

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Authorizing Statute(s): PL: Pub.L. 108 - 265 204 Name of Law: Child Nutrition and WIC Reauthorization
   US Code: 42 USC 301 Name of Law: Public Health Service Act
  

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:
	76 FR 7856	02/11/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 21747	04/18/2011
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 8

IC Title	Form No.	Form Name
Local Scheduling Worksheet	none	Site Visit Recruitment and Scheduling Worksheet
Interview with Community Representatives	none	Community Representative Interview Guide
Interview with School Administrators	none	School Administrators Interview Guide
Interview with Teachers	none	Teachers Interview Guide
Interview with Parents	none	Parent Interview Guide
Interview with Children K-1	none	Children K-1 Discussion Guide
Interview with Children Grades 2-4	none	Discussion Guide for Grades 2-4
Interview with Middle Schoolers	none	Discussion Guide for Middle Schoolers

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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	108	0	0	108	0	0
Annual Time Burden (Hours)	112	0	0	112	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 resubmission of the previously submitted ICR titled "Development and Evaluation of Eagle Books and Youth Eagle Books for American Indians and Alaska Natives" that was withdrawn by OMB. OMB waived the republication of a 30 day FRN.

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Annual Cost to Federal Government: $227,697

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]? No

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

Is this ICR related to the Pandemic Response? Uncollected

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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: 07/25/2011

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