Capacity Building Assistance Program: Assessment and Quality Control

Forms and Documents

Document Name	Status
Technical Assistance (TA) Satisfaction Instrument Form	Modified
Training Follow-Up Instrument (TFI) Form	Modified
Health Professional Application for Training (HPAT) Form	Modified
Att 16_Security Controls.docx Supplementary Document	2019-02-13
Att 15_Privacy Impact Assessment approved (12-10-2018).pdf Supplementary Document	2019-02-13
Att 12_TA Satisfaction Follow-up Reminder Email.docx Supplementary Document	2019-02-13
Att 11_Training Follow-up Reminder Email.docx Supplementary Document	2019-02-13
Att 10_TA Satisfaction Follow-up Instrument Email.docx Supplementary Document	2019-02-13
Att 9_Training Instrument Email.docx Supplementary Document	2019-02-13
Att 2_60-Day FRN.pdf Supplementary Document	2019-02-13
Att 1_Authorizing Legislation.docx Supplementary Document	2019-02-13
Supporting Statement B.docx Supporting Statement B	2019-02-13
Supporting StatementA.docx Supporting Statement A	2019-02-13

IC Document Collections

IC ID	Document Title	Status
217967	Att 16_CBA Key Informant Interview Script Other-WORD	Removed
217966	Technical Assistance Telephone Script for Nonresponders Other-phone script	Modified
217965	Training Telephone Script for Nonresponders Other-Phone Script	Modified
217676	Technical Assistance (TA) Satisfaction Instrument Form	Modified
217675	Training Follow-Up Instrument (TFI) Form	Modified
217674	Health Professional Application for Training (HPAT) Form	Modified

ICR Details

OMB Control No: 0920-1099	ICR Reference No: 201902-0920-009
Status: Historical Active	Previous ICR Reference No: 201611-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1099
Title: Capacity Building Assistance Program: Assessment and Quality Control
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: 04/09/2019
	Date Received in OIRA: 03/05/2019
Terms of Clearance: OMB is approving this information collection request for a period of 12 months during which time CDC will request approval to extend or revise the collection if CDC seeks to continue the information collection activity beyond the period approved under this action.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2020	12 Months From Approved	04/30/2019
Responses	44,400	0	44,440
Time Burden (Hours)	8,633	0	8,643
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this information collection is to assess how well the Capacity Building Branch's Capacity Building Assistance (CBA) program meets the needs of its consumers in order to enhance its capacity building strategy over time. The information will be collected from recipients of CBA services (health professionals at CBOs, health departments, and healthcare organizations). This assessment information will be used to improve program processes and operations. This revision removes the qualitative interview thereby reducing the burden. This revision requests one year of clearance.

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Authorizing Statute(s): US Code: 42 USC 792 Name of Law: Research and Investigations
  

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:
	83 FR 4524	09/06/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 7372	03/04/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Att 16_CBA Key Informant Interview Script
Training Telephone Script for Nonresponders
Technical Assistance Telephone Script for Nonresponders
Health Professional Application for Training (HPAT)	none, none	Health Professional Application for Training ,   Health Professional Application for Training - screenshots
Training Follow-Up Instrument (TFI)	none, none	Training Follow-up ,   Training Follow-up - screenshots
Technical Assistance (TA) Satisfaction Instrument	none, none	TA Satisfaction Follow-up ,   TA Follow-up -screenshots

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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	44,400	44,440	0	-40	0	0
Annual Time Burden (Hours)	8,633	8,643	0	-10	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The qualitative interview has been removed for this revision, reducing the burden by 10 hours. One year of approval is requested.

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Annual Cost to Federal Government: $726,734

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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

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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: 03/04/2019

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