Early Hearing Detection and Intervention - Pediatric Audiology Links to Service (EHDI-PALS) Facility Survey

Forms and Documents

Document Name	Status
EHDI-PALS Survey (review for previous participants) Form and Instruction	New
EHPI-PALS Facility Survey (first time participants) Form and Instruction	Modified
EHDI-PALS Facility Survey Introduction (drop-outs) Form and Instruction	Modified
Att 6_rpt684_IRB_Form2016.pdf Supplementary Document	2017-02-15
Att 5 EHDI PALs_Collaborators.docx Supplementary Document	2017-02-15
Att 4_Annual reminder to review.docx Supplementary Document	2017-02-15
Att 1b Authorizing Legislation_EHDI Act 2010.pdf Supplementary Document	2017-02-15
Att 1 Legal authority_PHSA.docx Supplementary Document	2017-02-15
EHDIPALS ICR B_2 15 2017.docx Supporting Statement B	2017-02-15
EHDIPALS ICR A _2 15 2017.docx Supporting Statement A	2017-02-15

IC Document Collections

IC ID	Document Title	Status
225731	EHDI-PALS Survey (review for previous participants) Form and Instruction	New
205423	EHPI-PALS Facility Survey (first time participants) Form and Instruction	Modified
205422	EHDI-PALS Facility Survey Introduction (drop-outs) Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0955	ICR Reference No: 201612-0920-011
Status: Historical Active	Previous ICR Reference No: 201402-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No: 12NT
Title: Early Hearing Detection and Intervention - Pediatric Audiology Links to Service (EHDI-PALS) Facility Survey
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: 05/22/2017
	Date Received in OIRA: 02/16/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2020	36 Months From Approved	05/31/2017
Responses	1,400	0	1,200
Time Burden (Hours)	64	0	180
Cost Burden (Dollars)	2,304	0	0

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Abstract: NCBDDD will collect data from pediatric audiologists who provide services to children age 5 and younger. The overall purpose of this study is to continue to identify and quantify the audiology facility resources in the U.S. Facility data will be compiled into a distribution map for CDC-EHDI team and state EHDI coordinators to visualize the geographic distribution of infants who are lost to follow up in relationship to the pediatric audiology clinic distribution. In this Revision the method of estimating burden has been refined and the total estimated burden has decreased.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
   US Code: 42 USC 280g-1 Name of Law: Early Hearing Detection and Intervention Act of 2010
  

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:
	81 FR 62138	09/08/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 10773	02/15/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
EHDI-PALS Facility Survey Introduction (drop-outs)	n/a	EHDI-PALS Survey (intro section)
EHPI-PALS Facility Survey (first time participants)	n/a	EHDI-PALS Survey
EHDI-PALS Survey (review for previous participants)	n/a	EHDI-PALS Survey

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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	1,400	1,200	0	200	0	0
Annual Time Burden (Hours)	64	180	0	-116	0	0
Annual Cost Burden (Dollars)	2,304	0	0	2,304	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: Miscellaneous Actions

Short Statement: The burden per response for a first-time participant is 9 minutes. In subsequent years, burden per response is reduced to 2 minutes, as previous respondents only need to review and update their information. In this Revision ICR, the 2 categories (first-time respondents, and previous respondents) have been disaggregated and separate estimates are provided for each category. The result is a net decrease in total estimated annualized burden hours.

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Annual Cost to Federal Government: $43,124

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: 02/16/2017

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