Assessment of Historically Black Colleges and Universities Activities to Eliminate Health Disparities

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form instrument #1 Assessment of Historically Black Colleges and Universities Activities to Eliminate Health Disparities	Form	New	Available
ss hbcu part b.doc	Supporting Statement B	Uploaded 2006-12-15	Available
ss hbcu july.doc	Supporting Statement A	Uploaded 2006-12-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
45007	Assessment of Historically Black Colleges and Universities Activities to Eliminate Health Disparities	Form	New

ICR Details

OMB Control No: 0915-0303	ICR Reference No: 200608-0915-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Assessment of Historically Black Colleges and Universities Activities to Eliminate Health Disparities
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: 12/18/2006
	Date Received in OIRA: 08/30/2006
Terms of Clearance: This ICR is approved on the condition that "<>" on page 2 of the revised informed consent form will be replaced, prior to fielding the survey, with the address for where respondents are to return the paper-version of the survey and the paper-version of the informed consent form.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2007	12 Months From Approved
Responses	525	0	0
Time Burden (Hours)	394	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: HRSA is conducting a survey of Historically Black Colleges and Universities (HBCUs) campus and community based activities directed toward the elimination of Health Disparities. This project is designed to examine the scope of activities currently being undertaken thoughout the nation's HBCUs.

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Authorizing Statute(s): PL: Pub.L. 106 - 525 807 Name of Law: Minority Health and Health Disparities Research and Education Act of 2000
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 7978	02/15/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 155	08/11/2006
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Assessment of Historically Black Colleges and Universities Activities to Eliminate Health Disparities	instrument #1, instrument #1	HBCU Survey ,   HBCU survey

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ICR Summary of Burden

table that charts list 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	525	0	0	525	0	0
Annual Time Burden (Hours)	394	0	0	394	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: No

Burden Reduction Due to:

Short Statement: This program change is a result of a one-time survey to obtain information from HBCUs that will provide HHS with a more comprehensive understanding of the variety and scope of projects being undertaken by HBCUs to eliminate health disparities.

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Annual Cost to Federal Government: $171

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: 08/30/2006

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