IHS Health Promotion/Disease Prevention Grantee Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
IHS Health Promotion/Disease Prevention Grantee Survey	Form	New	Available
HPDP supporting statement B 10-06-08.doc	Supporting Statement B	Uploaded 2008-11-06	Available
Section 301 of the Public Health Service Act.doc	Supplementary Document	Uploaded 2008-12-23	Available
IHS HPDP OMB SUPPORTING STATEMENT-rev060309.doc	Supporting Statement A	Uploaded 2009-06-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
187747	IHS Health Promotion/Disease Prevention Grantee Survey	Form	New

ICR Details

OMB Control No: 0917-0033	ICR Reference No: 200901-0917-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/IHS	Agency Tracking No:
Title: IHS Health Promotion/Disease Prevention Grantee Survey
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: 06/22/2009
	Date Received in OIRA: 01/07/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2012	36 Months From Approved
Responses	256	0	0
Time Burden (Hours)	256	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This is a request that the Office of Management and Budget (OMB) approve, under the Paperwork Reduction Act, an Indian Health Service (IHS) information collection initiative to fulfill an OMB request for an independent evaluation of the IHS Health Promotion/ Disease Prevention (HP/DP) grant program. Indian Health Service will contract with an external independent contractor to perform an objective evaluation of the HP/DP grant program, provide professional oversight and technical expertise in quantitatively evaluating the HP/DP grantees, make recommendations for improvement, identify best/promising practices for expansion, and propose strategies to enhance the overall HP/DP grant program. The evaluation services will require extensive analysis of program effectiveness, communication, coordination, and application of technical knowledge in program evaluation. The information collected will enable the HP/DP program to: a) Meet OMB request for an independent external evaluator to perform extensive analysis of HP/DP grant program effectiveness and prepare a final report. b) Meet requirements of the Government Performance and Results Act (GPRA), and c) Meet requirements of the Program Assessment Rating Tool (PART).

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: 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 50037	08/25/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 74725	12/09/2008
Did the Agency receive public comments on this ICR? Yes

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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
IHS Health Promotion/Disease Prevention Grantee Survey	none	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	256	0	0	256	0	0
Annual Time Burden (Hours)	256	0	0	256	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 new collection.

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Annual Cost to Federal Government: $5,800

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)? No

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: 01/07/2009

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