Section 510 State Abstinence Education Grant Program Guidance and Forms

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
6544	Section 510 State Abstinence Education Grant Program Guidance and Forms	Migrated

ICR Details

OMB Control No: 0915-0291	ICR Reference No: 200405-0915-002
Status: Historical Active	Previous ICR Reference No: 200411-0970-006
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Section 510 State Abstinence Education Grant Program Guidance and Forms
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/28/2004
	Date Received in OIRA: 05/18/2004
Terms of Clearance: Approved consistent with HRSA memo submitted to OMB 09/27/04. HRSA will report to OMB as soon as possible regarding the incorporation of this collection into an online data reporting system. In the event that HRSA is ready to create an online version of the collection prior to expiration of this approval request HRSA should submit an 83-I change form to OMB. Further, HRSA will report burden hours assciated with this collection between 01/01/04 and 05/18/04 as a violation of the Paperwork Reduction Act in the Information Collection Bulletin FY 04. Reporting of aggregate data associated with this collection should include a discussion of the limitations asscoiated with data collection, specifically addressing the fact that states may collect data on various performance measures through diffrent mechanisms.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2007	09/30/2007
Responses	51	0	0
Time Burden (Hours)	8,670	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The project consists of the grant application guidance and forms to be used in making applications for Abstinence Education formula grant funds under Section 510 of Title V of the Social Security Act (Public Law 101-239) and in preparing the required annual report.

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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
Section 510 State Abstinence Education Grant Program Guidance and Forms

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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	51	0	0	51	0	0
Annual Time Burden (Hours)	8,670	0	0	8,670	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? No

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: 05/18/2004

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