Evaluation of Core Violence and Injury Prevention Program

Forms and Documents

Document Name	Status
Form 4 Core VIPP Non-Funded SHD: SOTS Financial Module Form and Instruction	New
Form 3 Core VIPP Funded SHD: SOTS Financial Module Form and Instruction	New
Form 2 Core VIPP Non-funded State Health Department State of the States Survey Form and Instruction	New
Form 1 Core VIPP Funded State Health Department--State of the States Survey Form and Instruction	New
Supporting Statement B -11-17-2011.docx Supporting Statement B	2011-12-01
Attachment B - 60-Day FRN - PUBLISHED.pdf Supplementary Document	2011-12-01
Attachment A-TITLE 42--THE PUBLIC HEALTH AND WELFARE.docx Supplementary Document	2011-12-01
Supporting Statement A -11-17-2011.docx Supporting Statement A	2011-12-02

IC Document Collections

IC ID	Document Title	Status
200347	Core VIPP Non-Funded SHD: SOTS Financial Module Form and Instruction	New
200346	Core VIPP Funded SHD: SOTS Financial Module Form and Instruction	New
200345	Core VIPP Funded SHD: Telephone Interview Other-Telephone interview questions for Core VIPP Evaluation	New
200344	Core VIPP Non-funded State Health Department State of the States Survey Form and Instruction	New
200343	Core VIPP Funded State Health Department--State of the States Survey Form and Instruction	New

ICR Details

OMB Control No: 0920-0916	ICR Reference No: 201112-0920-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluation of Core Violence and Injury Prevention 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 without change	Conclusion Date: 01/16/2012
	Date Received in OIRA: 12/06/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2014	24 Months From Approved
Responses	128	0	0
Time Burden (Hours)	242	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this ICR is to permit CDC to evaluate the Core VIPP program for the benefit of the Core VIPP grantees. This ICR has two overall goals: (1) to assess state injury and violence prevention plans for completeness, measurability, and effectiveness; and (2) evaluate the effectiveness of the Core VIPP cooperative agreement.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: The Public Health and Welfare
  

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 41798	07/15/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 74066	11/30/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Core VIPP Funded State Health Department--State of the States Survey	1	State of the States Survey in PDF format
Core VIPP Non-funded State Health Department State of the States Survey	2	State of the States Survey in Word Format
Core VIPP Funded SHD: Telephone Interview
Core VIPP Funded SHD: SOTS Financial Module	3	Core VIPP Funded SHD: SOTS Financial Module
Core VIPP Non-Funded SHD: SOTS Financial Module	4	Core VIPP Non-Funded SHD: SOTS Financial Module

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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	128	0	0	128	0	0
Annual Time Burden (Hours)	242	0	0	242	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 new ICR.

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Annual Cost to Federal Government: $425,399

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? 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? 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: 12/06/2011

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