Privacy Narrative

Information Collection Request - Privacy Narrative
Community Based Survey of Supports for Healthy Eating and Active Living: National Survey 2.0

Title: ______________________________________________________________________________________
Deborah Galuska

Point of Contact: _____________________________________________________________________________
The purpose of this information collection is to conduct a second nationally representative survey of
municipalities in the U.S. to assess local governments' policies and practices that support healthy eating and
active living among their residents. The survey is being conducted on a random sample of municipal
governments that have at least 1000 persons in their jurisdiction. The key respondent will be the city or town
manager or planner or a person with similar responsibilities for the sampled municipality. The survey is a
self-administered questionnaire collected primarily via a secure, web-based interface; a paper option is
available at the request of the respondent. Questions include information about policies and practices that
mainly exist in local-level planning documents, such as policies that support changes in the built environment
to encourage physical activity and access to healthful food and beverages, and policies on breast-feeding. The
proposed information collection only requests information about the municipality policies and practices and
not the person responding. No confidential information about municipalities is being collected.
The contractor will have the name, official title, and the municipal address, phone number, and e-mail of the
key respondent in order to contact them for this study. This information is publicly available in the US Census
Bureau's 2017 Census of Governments or via municipal websites. The contractor will capture this information
in a separate system; CDC will not have access to this system and the contact information will never be part of
the study data set.
The Privacy Act does not apply.

Does this ICR request any PII?

✔ Yes

No

Business contact information only
If yes, describe: _____________________________________

Does this ICR include a form that requires a Privacy Act Statement?
Does this ICR require a PIA?

✔

Yes

No

Yes

✔

No

If yes, does a signed PIA already exist?

✔

C/I/O Approval
Associate Director for Science

Rachel
Kaufmann -S
Comments:

Digitally signed by Rachel
Kaufmann -S
Date: 2020.08.03
11:11:37 -04'00'

Information Systems Security Officer

Cynthia
Allen -S

Digitally signed by
Cynthia Allen -S
Date: 2020.08.03
11:14:39 -04'00'

Yes

No