Community-based Organization (CBO) Monitoring and Evaluation Project (CMEP) of WILLOW (CMEP-WILLOW)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 4 CMEP-WILLOW- 180-day Follow-up Survey	Form and Instruction	New	Repair queued
Form 3 CMEP-WILLOW- 90-day Follow-up Survey	Form and Instruction	New	Repair queued
Form 2 CMEP-WILLOW- Baseline Survey	Form and Instruction	New	Repair queued
Form 1 CMEP-WILLOW Eligibility Screener	Form and Instruction	New	Repair queued
0920-New_SS-Part B.doc	Supporting Statement B	Uploaded 2011-04-05	Repair queued
0920-New_att1_PHSAsect301.pdf	Supplementary Document	Uploaded 2011-04-05	Repair queued
0920-New_att4_Participation Agreement.pdf	Supplementary Document	Uploaded 2011-04-05	Repair queued
0920-New_att4_Participation Agreement.pdf	Supplementary Document	Uploaded 2011-04-05	Repair queued
0920-New_att4_Participation Agreement.pdf	Supplementary Document	Uploaded 2011-04-05	Repair queued
0920-New_SS-Part A.doc	Supporting Statement A	Uploaded 2011-04-13	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
197298	CMEP-WILLOW- 180-day Follow-up Survey	Form and Instruction	New
197297	CMEP-WILLOW- 90-day Follow-up Survey	Form and Instruction	New
197296	CMEP-WILLOW- Baseline Survey	Form and Instruction	New
197295	CMEP-WILLOW Eligibility Screener	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 201104-0920-009
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Community-based Organization (CBO) Monitoring and Evaluation Project (CMEP) of WILLOW (CMEP-WILLOW)
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 08/08/2011
	Date Received in OIRA: 04/13/2011
Terms of Clearance: This ICR has been withdrawn in order for the Program to provide updated burden estimates.

table that charts list comparision

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

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Abstract: The Community-based Organization (CBO) Monitoring and Evaluation Project (CMEP) of WILLOW has two purposes: 1) to monitor changes in client's self-reported HIV risk behaviors and attitudes after participating in the Effective Behavioral Intervention (EBI) WILLOW as delivered by CDC-funded CBOs and 2) to assess the fidelity of the delivery of WILLOW at CBOs. From July 2010 through July 2015, CMEP will provide additional funds through FOA 10-1003 to four CBOs to collect outcome monitoring data from 400 women who are living with HIV and participating in WILLOW as well as process and fidelity assessment data about the implementation of the interventions. CMEP-WILLOW will employ a repeated measures design to collect client-level data before the intervention and then again at three-months and six-months following the intervention. Findings will help to further understanding of how these interventions are delivered once they leave the research arena and whether or not they are associated with behavior change. Ultimately this information will help CBOs improve their intervention delivery and better serve clients

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Authorizing Statute(s): PL: Pub.L. 111 - 241 301 Name of Law: Research and Investigations Generally
  

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:
	76 FR 6139	02/03/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 18553	04/04/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
CMEP-WILLOW Eligibility Screener	1	CMEP-WILLOW Eligibililty Screener
CMEP-WILLOW- Baseline Survey	2	CMEP-WILLOW- Baseline Survey
CMEP-WILLOW- 90-day Follow-up Survey	3	CMEP-WILLOW- 90-day Follow-up Survey
CMEP-WILLOW- 180-day Follow-up Survey	4	CMEP-WILLOW- 180-day Follow-up Survey

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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 data collection

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Annual Cost to Federal Government: $752,475

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]? 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

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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: 04/13/2011

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