Evaluation of Ryan White HIV/AIDS Dental Reimbursement Program

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
6439	Evaluation of Ryan White HIV/AIDS Dental Reimbursement Program	Migrated

ICR Details

OMB Control No: 0915-0211	ICR Reference No: 199611-0915-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Evaluation of Ryan White HIV/AIDS Dental Reimbursement 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 without change	Conclusion Date: 01/03/1997
	Date Received in OIRA: 11/04/1996
Terms of Clearance: This information collection, as amended by the agency memoranda dated December 26, 1996 and January 2, 1997, is approved subject to the following terms of clearance: 1. The survey directed to the comparison sample shall incorpor- ate questions(s) that address why respondents have not applied for reimbursement. Such responses may consist of the following: reimbursement not sufficient to recover costs of service; patient s are covered by other insurance; not enough patients to justify paperwork; application too burdensome; didn't know about the pro- gram; other facilities offer services. These and other variables that may affect why a facility might not choose to apply for re- imbursement and/or provide services should be addressed in the final analysis. OMB wishes to note that without an adequate control sampling stra tegy, this study will not be able to provide a definitive evalua- tion of the success of reimbursement for dental care for AIDS and HIV infected patients. The principal effect of this study will be to determine the extent to which reimbursing for services improved attitudes and provision of service in recipient hospital s. The extent to which reimbursement caused hospitals to serve patients who would otherwise have been denied service cannot be determined with any level of accuracy.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/1997	09/30/1997
Responses	408	0	0
Time Burden (Hours)	561	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: A survey will be conducted of all accredited dental schools and post-doctoral dental programs to evaluate the impact the Ryan White HIV/AIDS Dental Reimbursement Program has had on the conduct of HIV/AIDS education and services. The survey will compare participating and nonparticipating dental schools and hospitals. Respondents will be asked to complete a mail questionnaire and a telephone interview.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Evaluation of Ryan White HIV/AIDS Dental Reimbursement Program

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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	408	0	0	408	0	0
Annual Time Burden (Hours)	561	0	0	561	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:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

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: 11/04/1996

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