Racial and Ethnic Approaches to Community Health across the U.S. (REACH U.S.) Evaluation

Forms and Documents

Document Name	Status
Form 2 Risk Factor Surveys (Interview and SAQ) Form and Instruction	Modified
Form 1 Screening Interview Form	Modified
SS_B REACH US Eval Revision.doc Supporting Statement B	2012-01-26
Attachment 8. Nonresponse Plan.doc Supplementary Document	2012-01-26
Attachment 7. MMWR Surveillance Summaries.pdf Supplementary Document	2012-01-26
Attachment 6. Table of Questionnaire Changes.docx Supplementary Document	2012-01-26
Attachment 4. Report on Incentive Experiments.docx Supplementary Document	2012-01-26
Attachment 3b. Summary of Public Comments.docx Supplementary Document	2012-01-26
Attachment 3a. Federal Register Notice.pdf Supplementary Document	2012-01-26
Attachment 1. Authorizing Legislation.doc Supplementary Document	2012-01-26
Attachment 2d. Advance Letter.doc Supplementary Document	2012-01-26
SS_A REACH US Eval Revision.doc Supporting Statement A	2012-01-26

IC Document Collections

IC ID	Document Title	Status
184630	Risk Factor Surveys (Interview and SAQ) Form and Instruction	Modified
184629	Screening Interview Form	Modified

ICR Details

OMB Control No: 0920-0805	ICR Reference No: 201202-0920-001
Status: Historical Active	Previous ICR Reference No: 200804-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Racial and Ethnic Approaches to Community Health across the U.S. (REACH U.S.) Evaluation
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: 03/02/2012
	Date Received in OIRA: 02/01/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2015	24 Months From Approved	03/31/2012
Responses	49,600	0	126,600
Time Burden (Hours)	9,460	0	9,875
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC requests OMB approval to collect two additional years of health risk factor information from a random sample of adults in 28 REACH US communities (900 individuals per community). Results will be used to evaluate the REACH US program and to monitor health trends in racial and ethnic minority populations.

---

Authorizing Statute(s): US Code: 42 USC 241 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:
	76 FR 62070	10/06/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 4044	01/26/2012
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Risk Factor Surveys (Interview and SAQ)	2, 3	Household Member Interview for Telephone Interviewing ,   Reach U.S. Study Booklet
Screening Interview	1	Household Screening Interview for Telephone Interviewing

---

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	49,600	126,600	0	-77,000	0	0
Annual Time Burden (Hours)	9,460	9,875	0	-415	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: Yes

Burden Reduction Due to: Changing Forms

Short Statement: The REACH US program is funded through a five-year cooperative agreement. Information has been collected for Years 1-3. The Revision request supports information collection in Years 4-5. Please note that the burden hours approved by OMB on 2/25/2009 reflect estimates in the original submission, which was received by OMB on 4/25/2008. However, the final OMB approval was based on a revised version of the supporting statement, dated 2/20/2009. The current Revision request represents a net increase in burden when compared to the 2/20/2009 version of the supporting statement. It represents a net decrease when compared to the original submission posted on 4/25/2008.

---

Annual Cost to Federal Government: $4,800,000

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

---

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: 02/01/2012

---