Multisite Evaluation of the In Community Spirit Program - Prevention of HIV/AIDS for Native/American Indian and Alaska Native Women Living in Rural and Frontier Indian Country

Forms and Documents

Document Name	Status
Attachment D.3 HEAL_Prevention Education Consent_Pretest_030712.doc Supplementary Document	2012-06-25
Attachment D.3 HEAL_Prevention Education Consent_Post_030712.doc Supplementary Document	2012-06-25
Attachment D.3 HEAL_Prevention Education Consent_followup_030712.doc Supplementary Document	2012-06-25
Attachment D.1 Key Informant Interviews Consent Script_Followup030712.doc Supplementary Document	2012-06-25
Attachment C_42 USC 241.pdf Supplementary Document	2012-06-25
Part B OMB ICS Multisite evaluation In Community Spirit 6 7 12.doc Supporting Statement B	2012-06-25
0990-Community Spirit_Attachment D.3 HEAL_Prevention Education Consent.doc Supplementary Document	2011-11-02
0990-Community Spirit_Attachment D 2 HEAL_Community Awareness Consent.doc Supplementary Document	2011-11-02
Attachment D.1 Key Informant Interviews Consent Script_Baseline030712.doc Supplementary Document	2012-06-25
Part A OMB ICS Multisite evaluation of In Community Spirit 062012.doc Supporting Statement A	2012-06-25

IC Document Collections

IC ID	Document Title	Status
200041	Community Member Other-Survey	New
200039	Healthcare support workers Other-Interview Form	New
200038	Health Educators Other-Interview Form	New

ICR Details

OMB Control No: 0990-0396	ICR Reference No: 201111-0990-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Multisite Evaluation of the In Community Spirit Program - Prevention of HIV/AIDS for Native/American Indian and Alaska Native Women Living in Rural and Frontier Indian Country
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: 06/29/2012
	Date Received in OIRA: 11/02/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2015	36 Months From Approved
Responses	1,860	0	0
Time Burden (Hours)	500	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The In Community Spirit Program is designed to increase HIV prevention knowledge and reduce the risk of contracting HIV among American Indian and Alaska Native women. The program has three components (prevention education, community awareness, and capacity building) and is implemented through six cooperative agreements. The evaluation of the In Community Spirit Program is multi-component, culturally competent, and multi-site. The evaluation includes key informant interviews with program staff and service providers to understand the facilitators and barriers of HIV prevention education, outreach and awareness, and capacity building across grantee programs as well as sustainability efforts related to these activities. The evaluation also includes surveys to be administered at pre, post, and 3 month follow up of an adapted, gender-based HIV prevention curriculum. The surveys examine women's knowledge, attitudes, awareness, and behaviors related to HIV and its prevention as well as stigma related to HIV testing and knowledge of testing sites. Because of the lack of information on evidence based practices for American Indian and Alaska Native women, this evaluation provides an opportunity to collect meaningful data on adapting existing evidence based practices to this population. Data gathered through the evaluation will be used to understand the extent to which the In Community Spirit Program has been able to achieve its goals and will enrich understandings of the way in which innovative programs impact quality and access to HIV prevention and intervention services for American Indian and Alaska Native women.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Section 301 Public Health Services 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 35443	06/17/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 66305	10/26/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Health Educators
Healthcare support workers
Community Member

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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	1,860	0	0	1,860	0	0
Annual Time Burden (Hours)	500	0	0	500	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

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Annual Cost to Federal Government: $110,203

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: 11/02/2011

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