SEPT 2020 Change Request to Allow Identification and Tracking of COVID-19 Activities

September 9, 2020

Change Request #1 for OMB #0923-0057: APPLETREE PERFORMANCE MEASURES

Justification for the Change Request

This is a non-material/non-substantive change request for OMB Control No. 0923-0057 (expiration date: July 31, 2020) titled “APPLETREE Performance Measures.”

In 2020, ATSDR awarded supplemental funds under its new Program Announcement titled “ATSDR's Partnership to Promote Local Efforts to Reduce Environmental Exposure - COVID-19 Supplement” (NOFO No. CDC-RFA-TS20-20010101SUPP20). In order to track COVID-19-related activities, ATSDR is requesting to make a non-substantive change to SharePoint and Word versions for the following forms:

• Attachment 4a (ATSDR HEAT Form);

• Attachment 4b (ATSDR TA Activity Form); and

• Attachment 4d (ATSDR Success Story Form).

The overall number of respondents and requested burden hours remain the same.

As such, ATSDR appreciates OMB’s consideration of this request.

Attachment	Requested Change
Att4a. ATSDR HEAT Form (SharePoint)	To each form, add the question – “Is activity related to COVID-19? (If yes, check box)”
Att4a. ATSDR HEAT Form (Word)
Att4b. ATSDR TA Activity Form (SharePoint)
Att4b. ATSDR TA Activity Form (Word)
Att4d. ATSDR Success Story Form (SharePoint)
Att4d. ATSDR Success Story Form (Word)

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