Improving the Understanding of Traumatic Brain Injury through Policy and Program Evaluation

Forms and Documents

Document Name	Status
Parent injury follow-up survey Form	New
Athlete injury follow-up survey Form	New
Parent weekly surveillance report Form	New
Athlete weekly surveillance report Form	New
Pre-season parent survey Form	New
Pre-season athlete survey Form	New
Pre-season coach survey Form	New
AttachQ_Law and Assoc Policy Character.docx Supplementary Document	2015-03-30
AttachP_Notification.docx Supplementary Document	2015-03-30
AttachO_Sample Table Shells.docx Supplementary Document	2015-03-30
Attachment N Consent forms 3-20.docx Supplementary Document	2015-03-30
AttachM - CSR USYSA Agreement.pdf Supplementary Document	2015-03-30
AttachL2 NCIPC Research Determination.pdf Supplementary Document	2015-03-30
AttachL1 IRB Approved letter Revised.pdf Supplementary Document	2015-03-30
AttachL IRB Approved letter.pdf Supplementary Document	2015-03-30
AttachK_Invitation letters_3-20.docx Supplementary Document	2015-03-30
AttachJ_Flyer_2-25.docx Supplementary Document	2015-03-30
AttachI_Advance Notice letter from USYSA_2-25.docx Supplementary Document	2015-03-30
AttachB1_Public Comment.docx Supplementary Document	2015-03-30
AttachB-60 day published notice_2014-09763.pdf Supplementary Document	2015-03-30
AttachA-Authorizing Legislation.docx Supplementary Document	2015-03-30
SSB_rev_2015-3-23-15.docx Supporting Statement B	2015-03-30
SSA_rev_2015-3-23-15.docx Supporting Statement A	2015-03-30

IC Document Collections

IC ID	Document Title	Status
215899	Parent injury follow-up survey Form	New
215898	Athlete injury follow-up survey Form	New
215897	Parent weekly surveillance report Form	New
215896	Athlete weekly surveillance report Form	New
215895	Pre-season parent survey Form	New
215894	Pre-season athlete survey Form	New
215893	Pre-season coach survey Form	New

ICR Details

OMB Control No: 0920-1073	ICR Reference No: 201503-0920-018
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 14VK
Title: Improving the Understanding of Traumatic Brain Injury through Policy and Program Evaluation
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: 06/26/2015
	Date Received in OIRA: 03/31/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2018	12 Months From Approved
Responses	35,956	0	0
Time Burden (Hours)	2,452	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: To determine whether the return-to-play policies followed by club soccer teams make a difference in the proportion of boys and girls ages 14 -18 who return to play with symptoms after a concussion injury, and to assess the relationship between CDC's Heads Up Initiative and concussion knowledge among youth soccer coaches, parents, and athletes. To improve efforts focused on youth athlete concussion prevention, evaluation, and management.

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Authorizing Statute(s): US Code: 42 USC 241 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:
	79 FR 24431	04/30/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 59271	10/01/2014
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Pre-season coach survey	none	Pre-season coach survey
Pre-season athlete survey	none	Pre-season athlete survey
Athlete weekly surveillance report	none	Athlete weekly surveillance report
Parent weekly surveillance report	none	Parent weekly surveillance survey
Parent injury follow-up survey	none	Parent injury follow-up survey
Pre-season parent survey	none	Pre-season parent survey
Athlete injury follow-up survey	none	Injury follow-up interview

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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	35,956	0	0	35,956	0	0
Annual Time Burden (Hours)	2,452	0	0	2,452	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 a new ICR.

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Annual Cost to Federal Government: $707,281

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: 03/31/2015

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