[NCIPC] Performance Monitoring of CDC’s Core State Injury Prevention Program

Forms and Documents

Document Name	Status
Form 0920-1369 Annual Progress Report Form	Modified
0920-1369 Att D3_Portal Training ManualV2.pdf Supplementary Document	2025-07-23
0920-1369 Att D2_ PerformMonitorFields.docx Supplementary Document	2025-07-23
0920-1369 Att D1_Partners Portal Screenshots.docx Supplementary Document	2025-06-25
0920-1369 Att C IRB determination.pdf Supplementary Document	2025-06-25
Attachment E_Privacy Act Applicability.pdf Supplementary Document	2021-12-22
Attachment C_Research Determination STARS.pdf Supplementary Document	2021-12-22
Attachment A_Authorizing_Legislation.docx Supplementary Document	2021-12-22
0920-1369_SSB_061125.docx Supporting Statement B	2025-06-25
0920-1369_ SSA_061125.docx Supporting Statement A	2025-06-25

IC Document Collections

IC ID	Document Title	Status
250897	Annual Progress Report Form	Modified

ICR Details

OMB Control No: 0920-1369	ICR Reference No: 202506-0920-017
Status: Received in OIRA	Previous ICR Reference No: 202111-0920-014
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1369
Title: [NCIPC] Performance Monitoring of CDC’s Core State Injury Prevention Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/23/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	09/30/2025
Responses	26	23
Time Burden (Hours)	286	253
Cost Burden (Dollars)	0	0

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Abstract: The goal of this ICR is to collect performance monitoring data via a web-based Partners’ Portal. This data is needed to monitor the cooperative agreement program funded under the Core State Injury Prevention Program (Core SIPP recipients of CE21-2101). Data collected will be used to monitor progress toward program goals, identify technical assistance needs of recipients, and to provide accountability for funding to the Department of Health and Human Services (HHS), the White House, Congress, and other sources, upon request. This revision request is to add three recipients to the data collection.

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Authorizing Statute(s): None

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:
	89 FR 95794	12/30/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 30644	07/10/2025
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Annual Progress Report	0920-1369	Core SIPP Program Annual Progress Report

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ICR Summary of Burden

	Total Request	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	26	23	0	3	0	0
Annual Time Burden (Hours)	286	253	0	33	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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 revision is for 286 burden hours and three years of approval. The estimated change in burden from the last OMB approval is 33 hours.

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Annual Cost to Federal Government: $248,471

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? No

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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: 07/23/2025

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