Formative Research and Tool Development

Forms and Documents

Document Name	Status
Example Consent Form.docx Supplementary Document	2012-11-26
Att 9 DHAP ConfidAssurance.doc Supplementary Document	2012-11-26
Att 7 Example Group Interview Guide.doc Supplementary Document	2012-11-26
Att 6 Sample Screening Tool.doc Supplementary Document	2012-11-26
Att 5 Example Survey.doc Supplementary Document	2012-11-26
Att 4 Example Individual Interview Guide.doc Supplementary Document	2012-11-26
Att 3 Example Questions.doc Supplementary Document	2012-11-26
Att 2 - 60 day FRN.pdf Supplementary Document	2012-11-26
Att 1 AuthLegislation.doc Supplementary Document	2012-11-26
0840 Generic- SSA.doc Supporting Statement A	2012-11-26

IC Document Collections

IC ID	Document Title	Status

ICR Details

OMB Control No: 0920-0840	ICR Reference No: 201212-0920-008
Status: Historical Inactive	Previous ICR Reference No: 200910-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Formative Research and Tool Development
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 01/31/2013
	Date Received in OIRA: 12/21/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2013	36 Months From Approved	01/31/2013
Responses	121,800	0	121,800
Time Burden (Hours)	46,516	0	46,516
Cost Burden (Dollars)	0	0	0

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Abstract: CDC requests approval for a revision of a generic information collection to supports formative research in HIV/AIDS, sexually transmitted diseases, tuberculosis, and viral hepatitis. Activities include the utility and acceptability of sampling, recruitment, and implementation methods, intervention contents and delivery, questionnaire domains and interactions with project staff.

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Authorizing Statute(s): US Code: 42 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:
	77 FR 46094	08/02/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 71794	12/04/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 0

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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: Increase in respondents and burden due to anticipated increase in individual projects under this generic clearance.

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Annual Cost to Federal Government: $574,500

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? 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: 12/21/2012

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