View Information Collection Request (ICR) Package
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View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0915-0338
ICR Reference No:
201012-0915-001
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
HHS/HSA
Agency Tracking No:
Title:
Evaluation of Core Components of the Federal Healthy Start Program
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:
05/16/2011
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/02/2010
Terms of Clearance:
This collection is approved with the understanding that this evaluation can provide information about how grantees are implementing the Healthy Start Program and about the outcomes experienced by program participants, but not establish association or a causal link between implementation strategies and outcomes. These limitations should be explained whenever the results are shared, reported, or published.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
05/31/2014
36 Months From Approved
Responses
102
0
0
Time Burden (Hours)
408
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
This is a one-time survey of Healthy Start Program staff. The data collection is designed to obtain information that will be used to assess program activities and services from the systems perspective. The overall purpose is to determine factors related to the successful implementation of the program, as well as the impact of Healthy Start in achieving key outcomes for participating women and children.
Authorizing Statute(s):
PL:
Pub.L. 101 - 239 501
Name of Law: Maternal and Child Health Services Block Grant
PL:
Pub.L. 110 - 339 122
Name of Law: Healthy Start Reauthorization
US Code:
42 USC 201
Name of Law: Public Health Service Act-
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
75 FR 22595
04/29/2010
30-day Notice:
Federal Register Citation:
Citation Date:
75 FR 63188
10/14/2010
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Healthy Start Survey
001_Healthy Start Survey_2010
Healthy Start Survey_2010
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
102
0
0
0
102
0
Annual Time Burden (Hours)
408
0
0
0
408
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$529,786
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
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
Agency Contact:
Amanda Cash 301 443-0208 amanda.cash@hrsa.hhs.gov
Common Form ICR:
No
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:
12/02/2010
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