Evaluation of Tribal Health Profession Opportunity Grants

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Attachment A11_Focus Group Recruitment Flyer.doc	Supplementary Document	Uploaded 2011-10-17	Available
Attachment A10_Telephone Interview Recruitment Letter.doc	Supplementary Document	Uploaded 2011-10-17	Available
Attachment A9_Focus Group Recruitment Letter.doc	Supplementary Document	Uploaded 2011-10-17	Available
Attachment A8_Administrative Staff, Implementation Staff, Employers Recruitment Letter.doc	Supplementary Document	Uploaded 2011-10-17	Available
Attachment A7_Grantee Advance Letter.doc	Supplementary Document	Uploaded 2011-10-17	Available
Attachment A6_NORC IRB Approval.doc	Supplementary Document	Uploaded 2011-10-17	Repair queued
Attachment A5_Focus Group Informed Consent Form.doc	Supplementary Document	Uploaded 2011-10-17	Available
Attachment A4_Interview Informed Oral Consent.doc	Supplementary Document	Uploaded 2011-10-17	Available
Attachment A2_Matrix of Questions that Appear in the PRS and Protocols.docx	Supplementary Document	Uploaded 2011-10-17	Available
Attachment A1_Public Health Service Law Sec 301.doc	Supplementary Document	Uploaded 2011-10-17	Available
tribal HPOG_Supporting Statement Part B_revised 10.11.11.doc	Supporting Statement B	Uploaded 2011-10-17	Available
Attachment A10_Focus Group Recruitment Flyer.doc	Supplementary Document	Uploaded 2011-06-20	Available
Attachment A9_Telephone Interview Recruitment Letter.doc	Supplementary Document	Uploaded 2011-06-20	Available
Attachment A8_Focus Group Recruitment Letter.doc	Supplementary Document	Uploaded 2011-06-20	Repair queued
Attachment A7_Administrative Staff, Implementation Staff, Employers Recruitment Letter.doc	Supplementary Document	Uploaded 2011-06-20	Repair queued
Attachment A6_Grantee Advance Letter.doc	Supplementary Document	Uploaded 2011-06-20	Available
Attachment A5_NORC IRB Approval.doc	Supplementary Document	Uploaded 2011-06-20	Repair queued
Attachment A4_Focus Group Informed Consent Form.doc	Supplementary Document	Uploaded 2011-06-20	Available
Attachment A3_Interview Informed Oral Consent.doc	Supplementary Document	Uploaded 2011-06-20	Available
Attachment A1_Public Health Service Law Sec 301.doc	Supplementary Document	Uploaded 2011-06-20	Available
tribal HPOG_Supporting Statement Part A_revised_10.11.11.doc	Supporting Statement A	Uploaded 2011-10-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
198409	#6.Program Non-Completers Interview Protocol	Other-#6	New
198408	#5.Program Completers Interview Protocol	Other-#5	New
198407	#4.Program Participant Focus Group and Interview Protocol	Other-#4	New
198406	#3.Employer interview	Other-#3	New
198405	#2.Program implementation staff interview	Other-#2	New
198404	#1.Grantee and partner administrative staff interview	Other-#1	New

ICR Details

OMB Control No: 0970-0395	ICR Reference No: 201107-0970-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Evaluation of Tribal Health Profession Opportunity Grants
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: 10/19/2011
	Date Received in OIRA: 07/06/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2014	36 Months From Approved
Responses	408	0	0
Time Burden (Hours)	485	0	0
Cost Burden (Dollars)	9,632	0	0

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Abstract: The Administration for Children and Families (ACF) is requesting Office of Management and Budget (OMB) approval to collect qualitative data through in-person and telephone interviews and focus groups as part of the evaluation of the Tribal Health Professions Opportunity Grants (HPOG) to develop an understanding of the Program's effectiveness in meeting the tribal health workforce needs. This project provides an opportunity for evaluating the implementation and outcomes of five distinct workforce development approaches that integrate health professional training programs with culturally-informed models of learning and practice.

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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 21749	04/18/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 38400	06/30/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
#1.Grantee and partner administrative staff interview
#3.Employer interview
#4.Program Participant Focus Group and Interview Protocol
#5.Program Completers Interview Protocol
#6.Program Non-Completers Interview Protocol
#2.Program implementation staff interview

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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	408	0	0	408	0	0
Annual Time Burden (Hours)	485	0	0	485	0	0
Annual Cost Burden (Dollars)	9,632	0	0	9,632	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 request.

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Annual Cost to Federal Government: $317,287

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

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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: 07/06/2011

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