View Information Collection Request (ICR) Package
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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:
201609-0915-003
Status:
Historical Active
Previous ICR Reference No:
201404-0915-007
Agency/Subagency:
HHS/HSA
Agency Tracking No:
Title:
National Healthy Start Evaluation and Quality Assurance
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
11/04/2016
Retrieve Notice of Action (NOA)
Date Received in OIRA:
09/20/2016
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
11/30/2019
36 Months From Approved
06/30/2017
Responses
102,207
0
41,183
Time Burden (Hours)
31,145
0
20,953
Cost Burden (Dollars)
0
0
0
Abstract:
The national Healthy Start (HS) evaluation will include an implementation evaluation, which will describe program components that affect outcomes; a health services utilization evaluation, which will examine the characteristics of women and infants who did and did not utilize the program; and an outcome evaluation, which will assess the program’s effectiveness with regard to producing expected outcomes among the target population. The information collected will be used to obtain consistent information across all 100 grantees about HS and its outcomes and in-depth information for 15 HS communities. Respondents include pregnant women and women of reproductive age that were served by HS and HS staff.
Authorizing Statute(s):
US Code:
42 USC 254c-8
Name of Law: Public Health Service Act
PL:
Pub.L. 110 - 339 122
Name of Law: Healthy Start Reauthorization Act of 2007
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:
81 FR 41314
06/24/2016
30-day Notice:
Federal Register Citation:
Citation Date:
81 FR 62911
09/13/2016
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
7
IC Title
Form No.
Form Name
Community Action Network (CAN) Survey
F
F. CAN Survey_revised.docx
Healthy Start Focus Group Protocol
Healthy Start Site Visit Protocol
National Healthy Start Program Survey (NHSPS)
E
E. NHSPS Survey_revised.docx
Redesigned Preconception, Pregnancy and Parenting (3P's) Information Form: Demographic Intake
B1
3Ps_Demographic Intake Form_revised.doc
Redesigned Preconception, Pregnancy and Parenting (3P's) Information Form: Pregnancy
B2
B2 3Ps_Pregnancy History Form_revised.doc
Redesigned Preconception, Pregnancy and Parenting (3P's) Information Forms 3-6
B3, B4, B5, B6
B3 3Ps_Preconception Form_revised.doc
,
B4 3Ps_Prenatal Form_revised.doc
,
B5 3Ps_Postpartum Form_revised.doc
,
B6 3Ps_Interconception_Parenting Form_revised.doc
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
102,207
41,183
0
61,024
0
0
Annual Time Burden (Hours)
31,145
20,953
0
10,192
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:
Yes
Burden Reduction Due to:
Using Information Technology
Short Statement:
The same individuals (40,675) complete the Demographic Intake and Pregnancy Status/History forms, and a subset of these same individuals (20,337) also complete the Preconception, Prenatal, Postpartum, and Interconception/Parenting forms for total of 61,532 respondents and responses. A revision in the 3Ps form added to the burden amount as the instrument was separated into 6 forms from the 1 form in 2013. Information technology has assisted in decreasing the burden for some instruments.
Annual Cost to Federal Government:
$186,719
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:
Elyana Bowman 301 443-3983 enadjem@hrsa.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:
09/20/2016
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