ACYF Pregnancy Prevention Performance Measure Collection

Forms and Documents

Document Name	Status
0990-PPA_Appendix C Example of AB Grantee Program Consent 5 1 12.docx Supplementary Document	2012-05-08
Appendix D Example of Evaluation Grantee Consent 5 1 2012.doc Supplementary Document	2012-05-08
0990ACYF_Performance Measure Section_B.docx Supporting Statement B	2011-10-18
0990-PM_Supporting_Statement_revised_5_2012_final.docx Supporting Statement A	2012-05-08

IC Document Collections

IC ID	Document Title	Status
199779	Grantee Program staff-Tier 1 C/D and Ter 2/PREIS Other-Performance Measure reporting form	New
199778	Grantee program staff-Tier 1 A/B Other-survey	New
199777	Youth Participating in programs Other-survey	New
199776	Grantee program staff Other-survey	New

ICR Details

OMB Control No: 0990-0392	ICR Reference No: 201110-0990-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: ACYF Pregnancy Prevention Performance Measure Collection
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: 05/09/2012
	Date Received in OIRA: 10/18/2011
Terms of Clearance: Approved as revised by HHS. OMB notes that the actual total number of approved responses is 50,654.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2015	36 Months From Approved
Responses	50,868	0	0
Time Burden (Hours)	7,197	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The performance measure collection is important to OAH and ACYF because it will provide the agency with data both to both effectively manage the TPP and PREIS programs, and to comply with accountability and federal performance requirements for the 1993 Government Performance and Results Act (P.L. 103-62). Moreover, collecting and reporting on data for performance measures are a funding requirement for the grants, as stated in the funding opportunity announcement.

---

Authorizing Statute(s): PL: Pub.L. 111 - 117 2 Name of Law: Consolidated Appropriation Act, 2010
   PL: Pub.L. 103 - 62 1 Name of Law: Government Performance and Results 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:
	76 FR 33760	06/09/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 53901	08/30/2011
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Grantee program staff
Youth Participating in programs
Grantee program staff-Tier 1 A/B
Grantee Program staff-Tier 1 C/D and Ter 2/PREIS

---

ICR Summary 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	50,868	0	0	50,868	0	0
Annual Time Burden (Hours)	7,197	0	0	7,197	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: New collection

---

Annual Cost to Federal Government: $326,333

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

---

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: 10/18/2011

---