View Information Collection Request (ICR) Package

OMB Control No: 0970-0462	ICR Reference No: 202112-0970-002
Status: Historical Active	Previous ICR Reference No: 202110-0970-005
Agency/Subagency: HHS/ACF	Agency Tracking No: OPRE
Title: OPRE Evaluation - National and Tribal Evaluation of the 2nd Generation of the Health Profession Opportunity Grants [descriptive evaluation, impact evaluation, cost-benefit analysis study, pilot study]
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/09/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/07/2021
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2024	07/31/2024	07/31/2024
Responses	7,298	0	7,298
Time Burden (Hours)	2,977	0	2,977
Cost Burden (Dollars)	0	0	0

Abstract: Between August 2015 and July 2019, OMB has approved several information collection instruments, procedures and supporting materials in support of the HPOG 2.0 National and Tribal Evaluation. These include baseline data collection from all study participants, data collection protocols and procedures for the HPOG 2.0 Tribal Evaluation, and several instruments in support of the National Evaluation, including Short-Term and Intermediate Follow-up Surveys to support the HPOG 2.0 National Evaluation impact study. In July 2021, OMB approved Instrument 12a COVID-Cohort Short-term Survey (COVID-19 Cohort STS) and supporting materials. Since approval, the following events have led to the need for minor changes so some of the currently approved information collection. • OPRE’s Privacy Analyst reviewed the advance letter (Attachment K) and requested changes. An updated Attachment K is included with this request. • While preparing to program the COVID-19 Cohort STS (Instrument 12a), the team identified revisions to language that would help with the clarity of the request. The team also had a change in staffing resulting in a necessary update to contact information. An updated Instrument 12a is included with this request. • The success of the Intermediate Follow-up Survey Critical Items Only (Instrument 18a)—which was still underway at the time the COVID-19 Cohort STS was submitted to OMB for review and approval – led the team to create a similar Critical Items Instrument for the COVID-19 Cohort STS. This Critical Items Survey is labeled as Instrument 12b and is included with this request.

Authorizing Statute(s): PL: Pub.L. 111 - 148 5507 , sec. 2008, (a)(3)(B) Name of Law: Patient Protection and Affordable Care 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:
	85 FR 83586	12/22/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 27624	05/21/2021
Did the Agency receive public comments on this ICR? No

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	7,298	7,298
Annual Time Burden (Hours)	2,977	2,977
Annual Cost Burden (Dollars)	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: The original burden estimate for Instrument 12a, the COVID-19 Cohort STS, was based on a presumed sample size of 7,500 study participants, a 75 percent response rate (5,625 responses), and a 60-minute length. The revised burden estimates reflect the same total number of responses (5,625), however, the overall response rate allows for 518 interviews to be completed using the shorter, critical items version of the COVID-19 Cohort STS (Instrument 12b). The shorter interview, the subject of this nonsubstantive change request, is estimated at just 20 minutes. The requested change reduces the original burden estimate for COVID-19 Cohort STS from 1,875 hours annually to 1,851 hours annually, a burden reduction of 6.2 percent annually. Burden estimates were reduced to 0 for Instrument 1 (PAGES Participant-level baseline data collection, tribal and non-tribal grantees) and for Instruments 18 and 18a now that the study enrollment and the Intermediate Follow-up survey data collection are complete.

Annual Cost to Federal Government: $2,915,650

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

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? Yes

Agency Contact: Molly Buck 202 205-4724 mary.buck@acf.hhs.gov

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