HAB Client Level Reporting

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 2-HAB_CL HAB Client-Level Provider Report	Form and Instruction	New	Available
Form 1-HAB-CL HAB Client-Level Grantee Report	Form and Instruction	New	Available
omb client questions followup.doc	Supplementary Document	Uploaded 2009-03-16	Available
9 - Vetting Participants.pdf	Supplementary Document	Uploaded 2008-11-17	Available
2 - CLD Workgroup Members.pdf	Supplementary Document	Uploaded 2008-11-17	Available
Supporting Statement FRN comments addressed 10-9-08 (3).doc	Supplementary Document	Uploaded 2008-11-17	Source copy available
ClientLevel SuppStatementA.doc	Supporting Statement A	Uploaded 2008-11-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
187336	HAB Client Report With Data Systems	Instruction	New
187335	HAB Client Report Without Data Systems	Instruction	New
187334	HAB Client-Level Provider Report	Form and Instruction	New
187333	HAB Client-Level Data Collection System	Instruction	New
187332	HAB Client-Level Grantee Report	Form and Instruction	New

ICR Details

OMB Control No: 0915-0323	ICR Reference No: 200811-0915-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: HAB Client Level Reporting
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: 03/26/2009
	Date Received in OIRA: 11/28/2008
Terms of Clearance: This ICR is approved for 2 years, consistent with HRSA memo of 3/13/09. During this time, HRSA will assess the quality of the information provided through the new data system and identify any technical assistance needed. For purposes of quality control, some respondents will be required to submit information to HRSA twice; however, HRSA agrees that this will be only for a finite period and primarily to assess the reliability of the data submissions. Upon resubmission, HRSA should describe in the supporting statement the revisions it has made--if any--as a result of the initial 24 month implementation of the new data system. HRSA should also discontinue the ICR the current reporting requirements are covered under. HRSA agrees that the the data from this system will not be used for PART purposes until CY 2012 (i.e. data from CY 2011 will be reported in CY 2012). Prior to implementation, HRSA further agrees to revise the instructions to eliminate references to "de-identified data," as the data being collected does not constitute "de-identified data" under the HIPAA privacy rule. The instructions and guidance should clarify that while identifiable health information is being disclosed to HRSA, this is authorized under the privacy rule for public health purposes. Further, HRSA agrees to clarify that although the client’s date of birth and gender make up the unique client ID, this information is encrypted with SHA-1 before it is sent to HRSA. As such, HRSA will never actually see the date of birth and gender information that make up the unique client identifier.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2011	36 Months From Approved
Responses	7,343	0	0
Time Burden (Hours)	88,190	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This is a new request for approval for the Client-Level Data Reporting System for the HIV/AIDS Bureau at the Health Resources and Services Administration that will be used to collect de-identified client-level data from grantees and service providers funded under the Ryan White HIV/AIDS Program.

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Authorizing Statute(s): PL: Pub.L. 109 - 415 101-703 Name of Law: Ryan White HIV/AIDS Treatment Modernization Act of 2006
  

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 39018	07/08/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 67527	11/14/2008
Did the Agency receive public comments on this ICR? Yes

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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
HAB Client-Level Grantee Report	1-HAB-CL	1-HAB-CL
HAB Client-Level Data Collection System
HAB Client-Level Provider Report	2-HAB_CL	2-HAB_CL
HAB Client Report Without Data Systems
HAB Client Report With Data Systems

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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	7,343	0	0	7,343	0	0
Annual Time Burden (Hours)	88,190	0	0	88,190	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 is a change in burden because it is a new activity.

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Annual Cost to Federal Government: $796,339

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: 11/28/2008

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