OMB Control No: 0920-1154
ICR Reference No:
201610-0920-009
Status: Historical Active
Previous ICR Reference No:
Agency/Subagency: HHS/CDC
Agency Tracking No: 16AVC
Title: CDC/ATSDR Formative Research
and Tool Development
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
with change
Conclusion Date: 01/19/2017
Retrieve
Notice of Action (NOA)
Date Received in OIRA:
10/26/2016
Terms of Clearance: OMB approves
this umbrella generic, and has informed CDC/ATSDR that each
individual study should be submitted into ROCIS an a genIC that
includes full supporting statement Part A and an accompanying
Supporting Statement Part B if any statistical methods are employed
for sampling or analyses of data. A complete justification for any
incentives offered to respondents will also accompany all
substudies submitted under this Generic. Outcomes collected under
this generic pathway are intended for internal ATSDR use only and
will not be generalized beyond the scope of each study or to
broader populations.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2020
36 Months From Approved
Responses
60,000
0
0
Time Burden (Hours)
56,250
0
0
Cost Burden (Dollars)
1,125,000
0
0
Abstract: CDC proposes a new generic clearance
to conduct formative research for developing new tools and
methodologies to support agency research, surveillance, and program
evaluation activities, and the development and assessment of
multi-use tools.
Authorizing Statute(s): US Code:
42
USC 241 Name of Law: PHSA
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:
81 FR
46680
07/18/2016
30-day Notice:
Federal Register Citation:
Citation Date:
81 FR
73112
10/24/2016
Did the Agency receive public comments on
this ICR? No
Number of Information Collection (IC) in this
ICR: 35
IC Title
Form No.
Form Name
BRFSS Preliminary
Experiment for Sample and Mode
Increase Enrollment in
the CDC-Recognized Lifestyle Change Program (LCP)
NA, NA, NA, NA
Pre-Session
Survey , Post-Session Survey ,
Enrollment
Materials and Referral Tracking Form , LCP Staff/Coach Interview
Guide
Federal Select Agent
Program eFSAP Feedback Survey
0920-1154, 0920-1154
FSAP Survey System
Enhancement , FSAP User Experience
Survey
Formative Research
with Clinicians for the Development of Quantitative Metrics to
Improve Antibiotic Prescribing Behavior in the Outpatient
Setting
Formative Research to
Identify Common and Unique Barriers to the Exchange of
Hospitalization and ED Data
none, none, none
Survey ,
Survey - word ,
Survey
prenotice
Formative Assessment
of the Information Needs to Prevent Skin Cancer Among Spanish
speaking Outdoor Workers
Formative Research for
Sepsis and Antibiotic Use Campaigns
none, none, none, none, none, none, none, none, none, none,
none, none, none, none, none
Sepsis Consumer
Screener - mothers , Sepsis Consumer Screener -
healthy adults 65+ , Sepsis Consumer Screener - AA
men , HCP
Sepsis Screener - ED triage nurse , HCP Sepsis Screener - NP or
PA , HCP
Sepsis Screener - PCP , HCP Sepsis Screener - Gen med
ward , Consumer Interview Sepsis ,
HCP Interview
Sepsis , HCP
Antibiotic Use Screener , Consumer Screener - SD-SE ,
Consumer
Screener - CD - CE , HCP Antibiotic Use
Interview , Consumer Interview - SE -
SD , Consumer Interview - CE -
CD
Formative Evaluation
for Shigellosis Sexual Health Materials for Men who have Sex with
Men
none
Screener
Disability and Health
Data System Evaluaton Survey
0920-1154
Disability and
Halth Data System Evaulation Survey
Formative Assessment
of Barriers to Transition from Adolescent to Adult for Individuals
with Congenital Heart Defects
none
Survey of Parents
of Adolescents with Congenital Heart Defects
Participatory Mapping
to Identy and Support at Risk Population in Emergency Preparedness
-- Phase 2
Formative Research to
Develop an Open Data Standard for Reporting Environmental Health
Data
0920-1154
Key Informant
Interview Plan
Reframing How We Talk
About Alcohol
none
Screener
FORMATIVE RESEARCH TO
DEVELOP ZIKA TOOLS FOR HEALTHCARE PROVIDERS
0920-1154, 0920-1154, 0920-1154
ACOG Zika Virus Survey ,
Focus Group
Recruitment Screen , ACOG Evaluation of Local Health
Department Initiative
Zika Family Survey:
In-Depth Interviews with Women Affected by Zika Virus
0920-1154
IN-DEPTH INTERVIEWS WITH WOMEN
AFFECTED BY THE ZIKA VIRUS - INTERVIEW GUIDE
Participatory Mapping
to Identify and Support At-Risk Populations in Emergency
Preparedness – Phase 3
0920-1154
Survey Disaster
Planners
Formative Assessment
of the Information Needs to Prevent Work-related Musculoskeletal
Disorders and Falls among Aging Retail Workers
Formative Research to
Inform an Intervention to Improve Early Detection and Surveillance
of Pneumoconiosis in US Coal Miners
none, none, none
Interview demographic
survey ,
Focus group
demographic survey , Interview sign-up
Participatory Mapping
to Identify and Support at-Risk Populations in Emergency
Preparedness
Persuasive
Communication about Risks from and Responses to Zika: FOCUS
GROUPS
NA
Focus Group -
Vignette
CDC's Inside Knowledge
Campaign: 2018 Focus Group Research and Testing with the General
Public and Hispanic Audiences
n/a, n/a, n/a, n/a
English Language
Screening Instrument , Spanish Language Screening
Instrument , English Language Focus Group
Discussion Guide , Spanish Language Focus Group
Discussion Guide
Behavioral
Determinants of Community Hand Hygiene Behavior: A Formative
Qualitative Evaluation
0920-1154, 0920-1154
Online Screener
, Focus Group
Moderator Guide
Ethnicity & Race:
Messaging to Improve Patient-Provider Communication and Engagement
on Risks of Alcohol Use During Pregnancy
0920-1154, 0920-1154, 0920-1154, 0920-1154
Consent Form
Provider (Online Survey) , Consent Form Provider In-Depth
Interview , Consent Form Women In-Depth
Interview , Provider Screener and Online
Survey
Reaching Minority Men
Where They Are – Formative Research to Build Capacity for
Enrollment in Diabetes Prevention and Management Programs
n/a, n/a, n/a, n/a, n/a
Focus Group Guide:
Minority Men at Risk for Type 2 Diabetes , Focus Group Guide: Minority Men
Diagnosed with Type 2 Diabetes , Screener , Initial Screen Shot of the
Web-based Survey (with OMB control information) ,
Survey
(content)
Assessment of the Zika
Care Connect Program
0920-1154, 0920-1154, 0920-1154, 0920-1154, 0920-1154
Invitation Email to
access Survey - Health Care Professional , Reminder Invitation Email to
access Survey - Health Care Professional , Survey - Healthcare
Professional , Pop-Up Invitation to Survey -
Website User , Survey - Website User
Older Adult Mobility
Ride Share (OAMRS)
0920-1154, 0920-1154, 0920-1154, 0920-1154, 0920-1154,
0920-1154, 0920-1154
Written
Questionnaire Focus Group , Focus Group Protocol -
Users , Focus Group Protocol -
Non-Users , Interview Protocol - Users
, Interview
Protocol - Non-Users , Screener Focus Group ,
Screener
Telephone Interview
Clinician Preferences
for CDC Clinical Guidelines
Formative Research to
Assess Pediatric Healthcare Providers Knowledge, Attitudes and
Practices around Zika Virus
none
Survey of
Experiences with and Attitudes towards Zika Virus
Core Elements of
Antimicrobial Stewardship in Nursing Homes
none
Prescriber
Assessment
BRFSS Feasibility
Experiment for State-specific Module Data Collection in Cell Phone
Samples
0920-1154
Questionnaire
Content
Focus Groups of US
Adults KAP of Foodborne Disease Outbreaks and Illness
Prevention
none, none
Recruitment
Screener , Recruitment Follow-up
Contact
2019 Updated B Reader
Certification Examination
Determination of
Attitudes Regarding Noise in Construction
0920-1154, 0920-1154, 0920-1154, 0920-1154
Construction
Industry Executive/Decision-Maker In-Depth Interviews ,
Construction
Supervisor/Foreman Focus Group , Construction Workers Focus
Groups (ENGLISH) , Construction Workers Focus
Groups (SPANISH)
Persuasive
Communication about Risks from and Responses to Zika – State, Local
and Tribal Government Interviews
NA
Interview Guide -
Public Health Officials
Antibiotic Stewardship
in Hospitals Assessment
none, none
Hospital Antibiotic
Stewardship Core Element Assessment , Feedback Questionnaire
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
60,000
0
0
60,000
0
0
Annual Time Burden (Hours)
56,250
0
0
56,250
0
0
Annual Cost Burden (Dollars)
1,125,000
0
0
1,125,000
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 new generic ICR.
Annual Cost to Federal Government: $474,091
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
Agency Contact: Shari Steinberg 404 639-4942
sxw2@cdc.gov