An Assessment of the Sustainability and Impact of Community Coalitions Once Federal Funding Has Expired

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Attachment_6_Verbal_Informed_Consent_for_Interviews1 (2).docx	Supplementary Document	Uploaded 2011-01-26	Available
Attachment_2_HCAP_Cover_Letter_draft_11 (2).docx	Supplementary Document	Uploaded 2011-01-26	Available
Attachment 9_5CFR13208[1].pdf	Supplementary Document	Uploaded 2011-01-10	Available
Attachment 8_CAP-HCAP.doc	Supplementary Document	Uploaded 2011-01-10	Available
Attachment 6_Verbal Informed Consent for Interviews.doc	Supplementary Document	Uploaded 2011-01-10	Repair queued
Attachment 5_Interview protocol.doc	Supplementary Document	Uploaded 2011-01-10	Available
Attachment 4_Interview Advance Letter.doc	Supplementary Document	Uploaded 2011-01-10	Repair queued
Attachment 3_HCAPQuestionnaire.doc	Supplementary Document	Uploaded 2011-01-10	Available
Attachment 2_HCAP Cover Letter_draft 1.doc	Supplementary Document	Uploaded 2011-01-10	Available
Attachment 1_Public Health Service Law sec 301.doc	Supplementary Document	Uploaded 2011-01-10	Available
section B 0990-Assessmentsustainabilityandimpact.doc	Supporting Statement B	Uploaded 2010-10-21	Available
0990-SustainabilityHCAP_revised_draft_10-1-101 (SSA revised ).docx	Supporting Statement A	Uploaded 2011-01-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
195028	Social and Community Service Managers/key informant interviews	Other-questionnaire	New
195027	Social and Community Service Managers/survey	Other-questionnarie	New

ICR Details

OMB Control No: 0990-0368	ICR Reference No: 201010-0990-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: An Assessment of the Sustainability and Impact of Community Coalitions Once Federal Funding Has Expired
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: 01/31/2011
	Date Received in OIRA: 10/27/2010
Terms of Clearance: Approved as revised.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2014	36 Months From Approved
Responses	300	0	0
Time Burden (Hours)	182	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: As part of the study a survey will be administered to the 260 coalitions funded through CAP/HCAP, providing a unique set of data to assess coalition sustainability and the factors that enable and hinder sustainability. The survey will focus on CAP/HCAP coalitions' sustainability, impact, and outcomes post-funding. The survey design and content is informed by a review of the literature on community coalitions including coalition functions, impact, and sustainability. The survey is designed to be consistent with the data from CAP/HCAP coalitions' six month monitoring reports (6MMRs) and built on the data collected as part of the national CAP/HCAP program evaluation conducted in 2004.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: U.S. Public Health Service Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 39693	07/12/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 62541	10/12/2010
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Social and Community Service Managers/survey
Social and Community Service Managers/key informant interviews

---

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	300	0	0	300	0	0
Annual Time Burden (Hours)	182	0	0	182	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.

---

Annual Cost to Federal Government: $141,008

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

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: 10/27/2010

---