Elder Justice Roadmap Project

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form OMB Number 1105-NE Elder Justice Roadmap Project	Form and Instruction	New	Available
Elder Statute_HIPAA fraud piece for OMB.pdf	Supplementary Document	Uploaded 2012-03-26	Available
Elder OMB Submission Part B_032612.doc	Supporting Statement B	Uploaded 2012-03-26	Available
Elder Supporting Statement Part A_032612.doc	Supporting Statement A	Uploaded 2012-03-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
200555	Elder Justice Roadmap Project	Form and Instruction	New

ICR Details

OMB Control No: 1105-0093	ICR Reference No: 201112-1105-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOJ/LA	Agency Tracking No:
Title: Elder Justice Roadmap 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 with change	Conclusion Date: 03/30/2012
	Date Received in OIRA: 12/21/2011
Terms of Clearance: Any reports or releases that are publicized in relation to this project will explicitly state that the results of the project are based on exploratory qualitative research by purposely selected, rather than random selected participants, and that the results are therefore not generalizable to any given population.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2015	36 Months From Approved
Responses	762	0	0
Time Burden (Hours)	1,508	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Under Authority 42 USC 1301, Section 1128B (HIPAA PL-104-191, Section 201, the Civil Division of the U.S. Department of Justice would request opinions about priorities for policy, practice, and research in the field of elder justice from researchers, practitioners, and advocates in fields related to elder abuse in order to provide a better understanding of the complex interrelationships between policy, practice, and research elements in the field of elder justice that would be useful to the Elder Justice Coordinating Council and the Advisory Board on Elder Abuse, Neglect, and Exploitation and to advance the knowledge base on the issue of elder justice and future programming in this area.

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Authorizing Statute(s): PL: Pub.L. 104 - 191 201 Name of Law: Health Insurance Portability and Accountability Act of 1996 (HIPAA)
  

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 20708	04/13/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 40932	07/12/2011
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
Elder Justice Roadmap Project	OMB Number 1105-NEW	Elder Justice Roadmap Project

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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	762	0	0	762	0	0
Annual Time Burden (Hours)	1,508	0	0	1,508	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: $417,872

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? Yes

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: 12/21/2011

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