Health Profession Opportunity Grants (HPOG) program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Instrument A.1 HPOG Performance Reporting System_revised 9_27_2011-2.doc	Supplementary Document	Uploaded 2011-09-28	Available
Instrument A.1 HPOG Performance Reporting System_revised 9_27_2011.doc	Supplementary Document	Uploaded 2011-09-28	Available
Revised Informed Consent Documentation 9-26-2011.docx	Supplementary Document	Uploaded 2011-09-28	Available
OMB Memo with Revised Package 9_27.docx	Supplementary Document	Uploaded 2011-09-28	Available
Supporting Statement Part B.doc	Supporting Statement B	Uploaded 2011-06-09	Available
Attachment A.1 Informed Consent.doc	Supplementary Document	Uploaded 2011-06-09	Available
Supporting Statement Part A Revised 9_28_FINAL-3 PM.doc	Supporting Statement A	Uploaded 2011-09-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
198341	#1. Semi-annual HPOG Program Performance Report	Other-#1. Semi-annual HPOG Program Performance Report	New

ICR Details

OMB Control No: 0970-0394	ICR Reference No: 201106-0970-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Health Profession Opportunity Grants (HPOG) program
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: 09/29/2011
	Date Received in OIRA: 06/29/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2014	36 Months From Approved
Responses	64	0	0
Time Burden (Hours)	1,997	0	0
Cost Burden (Dollars)	59,531	0	0

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Abstract: This data collection will monitor Health Profession Opportunity Grants (HPOG) program grantees providing Temporary Assistance for Needy Families (TANF) recipients, other low-income individuals, and members of Native American tribes with training and support needed to find and keep employment in health care occupations and fill the growing demand for skilled health care workers. The HPOG Performance Reporting System will monitor progress towards established goals and performance on key HPOG indicators, such as: enrollment, participation in training, completion of training, and obtaining employment in health care. The data collected by the system will also be used in current and future HPOG evaluation efforts.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 5507 Name of Law: Patient Protection and Affordable Care 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:
	76 FR 4912	01/27/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 35220	06/16/2011
Did the Agency receive public comments on this ICR? No

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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
#1. Semi-annual HPOG Program Performance Report

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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	64	0	0	64	0	0
Annual Time Burden (Hours)	1,997	0	0	1,997	0	0
Annual Cost Burden (Dollars)	59,531	0	0	59,531	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 data collection.

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Annual Cost to Federal Government: $166,997

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]? Yes

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: 06/29/2011

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