Children's Health after the Storms (CHATS)

Forms and Documents

Document Name	Status
Mail Verification Form for Baseline and 6-Month Fllow-up Visits (1% subsample) Form	Modified
Verification Questionnaire for Baseline and 6-Month Follow-up Visits (9% subsample) Form	Modified
Verification Quesionnaire for Eligibility Screener (10% subsample) Form	Modified
6-Month Follow-up: Session 2 (Parent Modules) Form and Instruction	Modified
6-Month Follow-up: Session 2 (Child Modules) Form and Instruction	Modified
6-Month Follow-up: Session 1 (Parent Modules) Form and Instruction	Modified
6-Month Follow-up: Session 1 (Child Modules) Form and Instruction	Modified
Baseline: Session 2 (Parent Modules) Form and Instruction	Modified
Baseline: Session 2 (Child Modules) Form and Instruction	Modified
Baseline: Session 1 (Parent Modules) Form and Instruction	Modified
Baseline: Session 1 (Child Modules) Form and Instruction	Modified
Eligibillity Screener Form	Modified
CHATS_ FAQs Attachment_C_revised_02272012_clean with OS edits_NCEH_4May12.docx Supplementary Document	2012-05-07
OMB Attachment New Outreach Materials_05042012.docx Supplementary Document	2012-05-07
CHATS School PEM letter_16Mar12_clean.docx Supplementary Document	2012-04-16
CHATS EnvSampler letter_16Mar12_clean.docx Supplementary Document	2012-04-16
CHATS Attachment X OMB _Study Results letters_Spanish.docx Supplementary Document	2012-04-16
CHATS Attachment U OMB_Sorry I Missed You Card_Spanish.docx Supplementary Document	2012-04-16
CHATS Attachment I OMB_Study Brochure_Spanish&Vietnamese.docx Supplementary Document	2012-04-16
CHATS Attachment H OMB_ IntroLetter_Spanish&Vietnamese.docx Supplementary Document	2012-04-16
CHATS Attachment F OMB_ConsentForms_Spanish&Vietnamese.docx Supplementary Document	2012-04-16
CHATS Attachment D OMB_Payment Receipt_Spanish.docx Supplementary Document	2012-04-16
CHATS Attachment C OMB_Websites_Spanish.docx Supplementary Document	2012-04-16
CHATS Justification of Change_Apr12_version 4.docx Justification for No Material/Nonsubstantive Change	2012-04-16
CHATS Attachment O OMB_6-Month Session_2_Spanish.docx Supplementary Document	2012-04-16
CHATS Attachment N OMB_6-Month Session_1_Spanish.docx Supplementary Document	2012-04-16
CHATS Attachment M OMB_Baseline Session 2_Spanish.docx Supplementary Document	2012-04-16
CHATS Attachment L OMB_Baseline Session_1_Spanish.docx Supplementary Document	2012-04-16
CHATS Attachment K OMB_EligibScreener_v3.5_Spanish.docx Supplementary Document	2012-04-16

IC Document Collections

IC ID	Document Title	Status
199172	Mail Verification Form for Baseline and 6-Month Fllow-up Visits (1% subsample) Form	Modified
199171	Verification Questionnaire for Baseline and 6-Month Follow-up Visits (9% subsample) Form	Modified
199170	Verification Quesionnaire for Eligibility Screener (10% subsample) Form	Modified
199169	6-Month Follow-up: Session 2 (Parent Modules) Form and Instruction	Modified
199168	6-Month Follow-up: Session 2 (Child Modules) Form and Instruction	Modified
199167	6-Month Follow-up: Session 1 (Parent Modules) Form and Instruction	Modified
199166	6-Month Follow-up: Session 1 (Child Modules) Form and Instruction	Modified
199165	Baseline: Session 2 (Parent Modules) Form and Instruction	Modified
199164	Baseline: Session 2 (Child Modules) Form and Instruction	Modified
199163	Baseline: Session 1 (Parent Modules) Form and Instruction	Modified
199162	Baseline: Session 1 (Child Modules) Form and Instruction	Modified
199161	Eligibillity Screener Form	Modified

ICR Details

OMB Control No: 0920-0925	ICR Reference No: 201204-0920-002
Status: Historical Active	Previous ICR Reference No: 201109-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Children's Health after the Storms (CHATS)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/07/2012
	Date Received in OIRA: 04/17/2012
Terms of Clearance: Prior Terms continue: Clearance is provided consistent with the understanding that this collection is designed to examine the feasibility of conducting a more robust study. Because this collection is not statistically rigorous enough to characterize the existence, size, or nature of the relationships between health outcomes and exposures, CDC has stated that they will not share underlying data outside of the agency and neither CDC nor its collaborators will disseminate the results of any analyses of the relationships between health outcomes and exposure. Upon submission of the next phase of this study to OMB, CDC will fully characterize the results of each of the methodological objectives described in the current collection.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2015	03/31/2015	03/31/2015
Responses	3,178	0	3,178
Time Burden (Hours)	1,310	0	1,310
Cost Burden (Dollars)	0	0	0

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Abstract: This request for change to CHATS is to provide the Spanish and Vietnamese translations for the project and new outreach materials. There is no change in burden or respondents.

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Authorizing Statute(s): 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

Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 12

IC Title	Form No.	Form Name
Baseline: Session 1 (Parent Modules)	none	CHATS Attachment L_revised_02272012
Baseline: Session 2 (Child Modules)	none	CHATS Attachment M_revised_02272012
Baseline: Session 2 (Parent Modules)	none	CHATS Attachment M_revised_02272012
6-Month Follow-up: Session 1 (Child Modules)	none	CHATS Attachment N_revised_02272012
6-Month Follow-up: Session 1 (Parent Modules)	none	CHATS Attachment N_revised_02272012
6-Month Follow-up: Session 2 (Child Modules)	none	CHATS Attachment O_revised_02272012
6-Month Follow-up: Session 2 (Parent Modules)	none	CHATS Attachment M_revised_02272012
Verification Quesionnaire for Eligibility Screener (10% subsample)	none	Verification for Screener
Verification Questionnaire for Baseline and 6-Month Follow-up Visits (9% subsample)	none	Verification for Interview
Mail Verification Form for Baseline and 6-Month Fllow-up Visits (1% subsample)	none	Mail Verification for Interview
Eligibillity Screener	none	CHATS Attachment K_revised_02272012
Baseline: Session 1 (Child Modules)	none	CHATS Attachment L_revised_02272012

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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	3,178	3,178	0	0	0	0
Annual Time Burden (Hours)	1,310	1,310	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $5,701,501

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: 04/17/2012

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