Adolescent Family Life Care Program Core Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0990-0290 Follow-up Survey	Form	New	Available
Form 0990-0290 Follow-up survey	Form	New	Repair queued
Form 0990-0290 Care Parenting	Form	New	Available
Form 0990-0290 Preganacy Teen	Form	Modified	Available
0990-0290.doc	Supporting Statement B	Uploaded 2008-09-03	Available
0990-0290_09-02-08.doc	Supporting Statement A	Uploaded 2008-09-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
186452	Grantee staff- Follow-up Care survey	Form	New	Follow-up Survey
186451	Grantee staff -Parenting adolescents	Other-questionnaire	New
186450	Follow-up survey (at birth)	Form	New	Follow-up survey
186449	Baseline Care survey for parenting adolescents	Form	New	Care Parenting
10423	Baseline Care Survey for Pregnant Adolescent	Form	Modified	Preganacy Teen

ICR Details

OMB Control No: 0990-0290	ICR Reference No: 200809-0990-002
Status: Historical Active	Previous ICR Reference No: 200506-0990-002
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Adolescent Family Life Care Program Core Evaluation
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/20/2009
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/05/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2012	36 Months From Approved	02/28/2009
Responses	41,965	0	12,600
Time Burden (Hours)	11,030	0	6,300
Cost Burden (Dollars)	0	0	0

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Abstract: Adolescent Family Life Care Programs provide services to pregnant and parenting adolescents. The proposed instruments developed for this evaluation permit measurement of standardized core outcomes for parents and their children across sites.

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Authorizing Statute(s): US Code: 42 USC 6A Name of Law: Subchapter XVIII Public Health Service Act
  

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:
	73 FR 32583	06/09/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 49675	08/22/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Baseline Care Survey for Pregnant Adolescent	0990-0290	Preganacy Teen
Baseline Care survey for parenting adolescents	0990-0290	Care Parenting
Follow-up survey (at birth)	0990-0290	Follow-up survey
Grantee staff -Parenting adolescents
Grantee staff- Follow-up Care survey	0990-0290	Follow-up 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	41,965	12,600	0	29,365	0	0
Annual Time Burden (Hours)	11,030	6,300	0	4,730	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: Miscellaneous Actions

Short Statement: There are no increases in burden requested because the grantees are already conducting baseline and follow-up data collection as part of the grant funding requirements. Furthermore, we are not creating new documents and not increasing sample size for this data collection. In fact, the instruments have been shortened from a 30-minute administration to a 23-minute administration, reducing burden.

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Annual Cost to Federal Government: $486,195

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: 09/05/2008

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