Hemophilia and AIDS/HIV Network for the Dissemination of Information (HANDI) Evaluation Support

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Consent for parents	Form	New	Available
Consent for 16-17 year olds	Form	New	Available
Consent for 18-19 year olds	Form	New	Available
Moderator's Guide for Parents	Form	New	Available
Form nopne Moderator's Guide for 16-19 years old	Form	New	Available
Respondent screener parents of children 5-12 years old	Form	New	Available
Respondent screener 18-18 year olds	Form	New	Available
Respondent screener 16-17 year olds	Form	New	Available
Section_B_Supporting Statement.doc	Supporting Statement B	Uploaded 2010-04-28	Available
REV_Attachment_10.docx	Supplementary Document	Uploaded 2010-04-28	Available
Attachment_13 IRB findings and approval.pdf	Supplementary Document	Uploaded 2010-04-28	Available
Attachment_12_HANDI Recruitment Flyers OMB.pdf	Supplementary Document	Uploaded 2010-04-28	Available
Attachment_1A public health sevice act .doc	Supplementary Document	Uploaded 2010-04-28	Available
Attachment_2_60-DayFRN.pdf	Supplementary Document	Uploaded 2010-04-28	Available
Attachment_1B Children's Health Act 2000.pdf	Supplementary Document	Uploaded 2010-04-28	Available
REV_Attachment_11.docx	Supplementary Document	Uploaded 2010-04-28	Available
Section_A_Supporting Statement.doc	Supporting Statement A	Uploaded 2010-04-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
192852	Consent	Form	New	Consent for parents
192852	Consent	Form	New	Consent for 16-17 year olds
192852	Consent	Form	New	Consent for 18-19 year olds
192851	Moderator's Guide	Form	New	Moderator's Guide for Parents
192851	Moderator's Guide	Form	New	Moderator's Guide for 16-19 years old
192850	Respondent Screener	Form	New	Respondent screener parents of children 5-12 years old
192850	Respondent Screener	Form	New	Respondent screener 18-18 year olds
192850	Respondent Screener	Form	New	Respondent screener 16-17 year olds

ICR Details

OMB Control No: 0920-0858	ICR Reference No: 201005-0920-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Hemophilia and AIDS/HIV Network for the Dissemination of Information (HANDI) Evaluation Support
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 without change	Conclusion Date: 07/23/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/10/2010
Terms of Clearance: CDC will report back to OMB on the response rate achieved at the approved incentive rate.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2011	12 Months From Approved
Responses	336	0	0
Time Burden (Hours)	197	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: In September 2009, CDC initiated the National Hemophilia Foundation's (NHF) Hemophilia and AIDS/HIV Network for the Dissemination of Information (HANDI) project. HANDI is NHF's resource center that provides information, materials, and support to people with bleeding and clotting disorders. Many materials focus on parents and family members of newly diagnosed children, but less attention is given to materials for children and adolescents, especially about acceping the disorder, self-care, school and career planning. Focus groups will be conducted to ensure the health promotional materials are useful and on target.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
   US Code: 42 USC 247 Name of Law: Children's Health 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:
	74 FR 26246	06/01/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 22137	04/27/2010
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Consent	none, none, none	Consent for 16-17 year olds ,   Consent for parents ,   Consent for 18-19 year olds
Moderator's Guide	nopne, none	Moderator's Guide for 16-19 years old ,   Moderator's Guide for Parents
Respondent Screener	none, none, none	Respondent screener 16-17 year olds ,   Respondent screener 18-18 year olds ,   Respondent screener parents of children 5-12 years old

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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	336	0	0	336	0	0
Annual Time Burden (Hours)	197	0	0	197	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 ICR.

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Annual Cost to Federal Government: $171,076

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? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

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: 05/10/2010

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