Generic Clearance to Support the Safe to Sleep Campaign at the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD)

Forms and Documents

Document Name	Status
Form 1 Alabama Safe Sleep Outreach Project Form	New
Form 1 Alabama Safe Sleep Outreach Project Form and Instruction	New
Form 1 Safe to Sleep National Champions Tracking and Feedback Form Form and Instruction	New
Form 1 Safe to Sleep National Champions Tracking and Feedback Form Form and Instruction	New
Form 1 Safe to Sleep National Champions Tracking and Feedback Form Form and Instruction	New
Form 1 Healthy Native Babies (HNB) Project Materials Distribution Form and Instruction	New
Form 1 Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment Form and Instruction	New
Form 1 Healthy Native Babies Project Materials Distribution Form and Instruction	New
Form 1 Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment Form and Instruction	New
Attach 1B_Sub-study Memo Template.doc Supplementary Document	2014-05-29
Attach 1A_Generic Information Collection Request ICR Template.doc Supplementary Document	2014-05-29
SSB_Safe_To_Sleep_Campaign_NICHD_3-28-14.docx Supporting Statement B	2014-05-29
SSA_Safe_To_Sleep_Campaign_NICHD_7-21-14. REV.doc Supporting Statement A	2014-07-29

IC Document Collections

IC ID	Document Title	Status
224261	Alabama Safe Sleep Outreach Project Form	New
220000	Alabama Safe Sleep Outreach Project Form and Instruction	New
214193	Safe to Sleep National Champions Tracking and Feedback Form Form and Instruction	New
214192	Safe to Sleep National Champions Tracking and Feedback Form Form and Instruction	New
214191	Safe to Sleep National Champions Tracking and Feedback Form Form and Instruction	New
213926	Healthy Native Babies (HNB) Project Materials Distribution Form and Instruction	New
213921	Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment Form and Instruction	New
213751	Healthy Native Babies Project Materials Distribution Form and Instruction	New
213691	Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment Form and Instruction	New

ICR Details

OMB Control No: 0925-0701	ICR Reference No: 201403-0925-009
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Generic Clearance to Support the Safe to Sleep Campaign at the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD)
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 with change	Conclusion Date: 07/30/2014
	Date Received in OIRA: 05/29/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	36 Months From Approved
Responses	7,500	0	0
Time Burden (Hours)	3,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This is a request for a new generic clearance that would be used for submissions specific to the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Safe to Sleep (STS) public education campaign. Submissions for the STS campaign will be used to assess the understanding and reach of STS campaign materials and messages, and to monitor and improve campaign activities such as training workshops and overall implementation. The purpose of this information collection is to monitor and modify campaign activities, to plan future campaign activities, to develop messages and materials, and to develop distribution and outreach strategies that are effective at communicating their message to bring about the intended response, awareness, and/or behavioral change for the target audiences. This generic clearance will enable the NICHD to: 1) more efficiently assess the implementation of campaign activities; 2) better understand the target audiences' knowledge, attitudes, and beliefs toward STS messages and materials; 3) better understand how the campaign activities have influenced the target audiences' behaviors and practices; and 4) monitor and improve activities such as trainings, and material/message development. Having a way to gather feedback on the STS campaign activities is critical to assessing the reach and effect of campaign efforts. Data collected for the campaign can inform where future STS campaign resources can produce the most meaningful results.

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Authorizing Statute(s): US Code: 42 USC 285 Name of Law: The 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:
	78 FR 79472	12/30/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 30856	05/29/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 9

IC Title	Form No.	Form Name
Healthy Native Babies Project Materials Distribution	1	Tracking Form
Safe to Sleep National Champions Tracking and Feedback Form	1	National Champions Tracking and Feedback Screenshots
Alabama Safe Sleep Outreach Project	4, 2, 3, 5, 1	Alabama Outreach Activity Tracking form ,   Alabama Outreach Assessment Form ,   Alabama Outreach Photo Video Consent Form ,   Alabama Outreach Required Form ,   Alabama Outreach Sign In Sheet
Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment	1	Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment Survey
Alabama Safe Sleep Outreach Project	3, 1, 2, 4	Substudy AlabamaOutreach PaperworkChecklist ,   Substudy AlabamaOutreach PrePostAssessment ,   Substudy AlabamaOutreach Activity/Tracking ,   Substudy AlabamaOutreach Signin
Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment	1	Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment Survey
Healthy Native Babies (HNB) Project Materials Distribution	1	Healthy Native Babies Project Materials Distribution Tracking Form
Safe to Sleep National Champions Tracking and Feedback Form	1	National Champions Tracking and Feedback Screenshots
Safe to Sleep National Champions Tracking and Feedback Form	1	National Champions Tracking and Feedback Screenshots

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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	7,500	0	0	7,500	0	0
Annual Time Burden (Hours)	3,000	0	0	3,000	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 ICR.

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Annual Cost to Federal Government: $69,267

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: 05/29/2014

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