Evaluation of the Technical Assistance to ARRA Complex Patient Grantees Project

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form #5 Annual Interview	Form and Instruction	New	Available
Form Form #4 Annual Survey	Form and Instruction	New	Available
Form Form #3 Individual TA Evaluation	Form and Instruction	New	Available
Form Form #2 Group TA Evaluation	Form and Instruction	New	Available
Form Form #1 LN Meeting Evaluation	Form and Instruction	New	Available
Supporting Statement Part B -- Eval of the TA to ARRA Complex Patient Grantees - 10-5-2011.doc	Supporting Statement B	Uploaded 2011-10-07	Available
Attachment F -- Federal Register Notice.pdf	Supplementary Document	Uploaded 2011-10-07	Available
Supporting Statement Part A -- Eval of the TA to ARRA Complex Patient Grantees - 10-5-2011.doc	Supporting Statement A	Uploaded 2011-10-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
199735	Annual Interview	Form and Instruction	New
199734	Annual Survey	Form and Instruction	New
199733	Individual TA Evaluation	Form and Instruction	New
199732	Group TA Evaluation	Form and Instruction	New
199731	LN Meeting Evaluation	Form and Instruction	New

ICR Details

OMB Control No: 0935-0187	ICR Reference No: 201110-0935-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Evaluation of the Technical Assistance to ARRA Complex Patient Grantees Project
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: 12/01/2011
	Date Received in OIRA: 10/12/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2014	36 Months From Approved
Responses	96	0	0
Time Burden (Hours)	19	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: In order to support its' R21 and R24 complex patient grantees, AHRQ funded a Learning Network and Technical Assistance Center (LN&TAC) to encourage collaboration among the researchers and help them share research methods, definitions and products through in-person meetings, small workgroups and network facilitation. The LN&TAC will provide the grantees with technical assistance regarding research design, data collection, data analysis, public use dataset development, and dissemination. The purpose of this Information Collection Request is to evaluate the effectiveness of the LN&TAC.

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
  

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 46811	08/03/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 61707	10/05/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
LN Meeting Evaluation	Form #1	LN Meeting Evaluation
Group TA Evaluation	Form #2	Group TA Evaluation
Individual TA Evaluation	Form #3	Individual TA Evaluation
Annual Survey	Form #4	Annual Survey
Annual Interview	Form #5	Annual 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	96	0	0	96	0	0
Annual Time Burden (Hours)	19	0	0	19	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 Information Collection Request.

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Annual Cost to Federal Government: $59,379

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)? Yes

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: 10/12/2011

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