Preventive Health and Health Services Block Grant

Forms and Documents

Document Name	Status
Att H_NonResearch Determnation Form_Final.pdf Supplementary Document	2019-06-27
Att G_Privacy Act Checklist_Final.docx Supplementary Document	2019-06-27
Att F_Published 60dy FRN.pdf Supplementary Document	2019-06-27
Att C_PL102-531[1].pdf Supplementary Document	2019-06-27
Att B_42_USC_300w.doc Supplementary Document	2019-06-27
Att A_List_of_FY_2018_Awardees Final.docx Supplementary Document	2019-06-27
Statement B-Block Grant ICR_Final.docx Supporting Statement B	2019-06-27
Statement A-Block Grant ICR_2019_Final updated April 2019.docx Supporting Statement A	2019-06-27

IC Document Collections

IC ID	Document Title	Status
6636	Att 4A_Work Plan Instrument Other-WORD	Modified
184866	Att 5A_Annual Report Instrument Other-WORD	Modified

ICR Details

OMB Control No: 0920-0106	ICR Reference No: 201906-0920-011
Status: Active	Previous ICR Reference No: 201605-0920-015
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0106
Title: Preventive Health and Health Services Block Grant
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: 08/06/2019
	Date Received in OIRA: 07/02/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2022	36 Months From Approved	08/31/2019
Responses	122	0	122
Time Burden (Hours)	2,135	0	2,135
Cost Burden (Dollars)	0	0	0

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Abstract: CDC currently collects information from Block Grant awardees to monitor their objectives and activities(Preventive Health and Health Services Block Grant, OMB No. 0920-0106, exp. 7/31/2019 ). Each awardee is required to submit an annual application for funding (Work Plan) that describes its objectives and the populations to be addressed, and an Annual Report that describes activities, progress toward objectives and Success Stories which highlight the improvements Block Grant program.

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Authorizing Statute(s): US Code: 45 USC 96.1-96.17 Name of Law: Block Grants
   PL: Pub.L. 102 - 531 101-104 Name of Law: Preventive Health and health Services Block Grant
   US Code: 42 USC 300w-300w-8 Name of Law: Preventive Health and Health Services Block Grants
  

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:
	84 FR 5450	02/21/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 26115	06/05/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Att 4A_Work Plan Instrument
Att 5A_Annual Report Instrument

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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	122	122	0	0	0	0
Annual Time Burden (Hours)	2,135	2,135	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: $76,453

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.     No

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.     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: 07/02/2019

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