Audience Profiling for Carbon Monoxide Poisoning

Forms and Documents

Document Name	Status
A9 Triad Consent Form_02.11.09.doc Supplementary Document	2009-02-24
A8 Generator owners Consent Form_02.11.09.doc Supplementary Document	2009-02-24
A7 Homeowners Consent Form_02.11.09.doc Supplementary Document	2009-02-24
A16 CDC IRB Deferral_02.11.09.doc Supplementary Document	2009-02-24
A3 RTI IRB Forms_02.11.09.doc Supplementary Document	2009-02-23
A2 60dy FRN_02.11.09.doc Supplementary Document	2009-02-23
A1 Legislation_02.11.09.doc Supplementary Document	2009-02-23
Supporting Statement A_021109.doc Supporting Statement A	2009-03-03

IC Document Collections

IC ID	Document Title	Status
188649	Generator Owner: Exit Questionnaire Other-WORD	New
188648	Home Appliance Owner: Exit Questionnaire Other-WORD	New
188647	Generator Owner: Traid Discussion Guide Other-WORD	New
188646	Home Appliance Owner: Traid Discussion Guide Other-WORD	New
188645	Generator Owner: Focus Group Discussion Guide Other-WORD	New
188644	Home Appliance Owner: Focus Group Discussion Guide Other-WORD	New
188643	Expert (Telphone Interview) Discussion Guide Other-WORD	New
188642	Generator Owner: Traid Screener Other-WORD	New
188641	Home Appliance Owner: Traid Screener Other-WORD	New
188640	Generator Owner: Focus Group Screener Other-WORD	New
188639	Home Appliance Owner: Focus Group Screener Other-WORD	New

ICR Details

OMB Control No: 0920-0809	ICR Reference No: 200904-0920-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Audience Profiling for Carbon Monoxide Poisoning
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/29/2009
	Date Received in OIRA: 04/02/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2012	36 Months From Approved
Responses	404	0	0
Time Burden (Hours)	276	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Carbon monoxide (CO) is one of the leading causes of poison-related deaths in the United States. The Centers for Disease Control and Prevention (CDC) estimates that each year approximately 500 people die of unintentional, nonfire-related CO exposure, and another 15, 000 individuals visit emergency rooms for treatment from exposure to CO gas. This study aims to address questions which remain about when and how individuals use CO-emitting products, why they engage in certain risk behaviors, how best to inform them about the CO poisoning, and how receptive they are to existing prevention materials, through assessign the basis for current audience knowledge, attitudes and practices, and ultimately strengthen educational materials about CO.

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Authorizing Statute(s): US Code: 3 USC 241 Name of Law: Public Health Service Act
  

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:
	73 FR 53876	09/17/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 8544	02/25/2009
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 11

IC Title	Form No.	Form Name
Home Appliance Owner: Focus Group Screener
Generator Owner: Focus Group Screener
Generator Owner: Traid Screener
Home Appliance Owner: Traid Screener
Expert (Telphone Interview) Discussion Guide
Home Appliance Owner: Focus Group Discussion Guide
Generator Owner: Focus Group Discussion Guide
Home Appliance Owner: Traid Discussion Guide
Generator Owner: Traid Discussion Guide
Home Appliance Owner: Exit Questionnaire
Generator Owner: Exit Questionnaire

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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	404	0	0	404	0	0
Annual Time Burden (Hours)	276	0	0	276	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 is a new information collection.

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Annual Cost to Federal Government: $138,410

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

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: 03/22/2009

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