ASSESSING FACTORS THAT IMPACT AIDS DRUG ASSISTANCE PROGRAM (ADAP) ENROLLMENT MANAGEMENT IN THE FACE OF ADAP WAITING LISTS

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 ADAP site visit	Form	New	Available
Appendix F _ ADAP Access Study IRB Exemption.doc	Supplementary Document	Uploaded 2012-05-04	Repair queued
Appendix E_ADAP Pilot State Interviews Participant List 5-2-12.docx	Supplementary Document	Uploaded 2012-05-04	Repair queued
Appendix A Ryan White legislation.pdf	Supplementary Document	Uploaded 2012-05-02	Repair queued
Appendix B ADAP Evaluation Plan FINAL.doc	Supplementary Document	Uploaded 2012-05-02	Repair queued
FINAL ADAP OMB Supporting Statement Revised.doc	Supporting Statement A	Uploaded 2012-08-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202186	ADAP site visit	Form	New

ICR Details

OMB Control No:	ICR Reference No: 201205-0915-002
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: ASSESSING FACTORS THAT IMPACT AIDS DRUG ASSISTANCE PROGRAM (ADAP) ENROLLMENT MANAGEMENT IN THE FACE OF ADAP WAITING LISTS
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: Not subject to PRA	Conclusion Date: 08/05/2012
	Date Received in OIRA: 05/08/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This is the second part of a two-part study assessing factors that impact how AIDS Drug Assistance Programs are managing increases in program enrollment. This study is examining case study site visits, which entails face-to-face interviews using semi-structured discussion guides.

---

Authorizing Statute(s): PL: Pub.L. 106 - 415 2623 Name of Law: Ryan White HIV/AIDS Treatment Extension Act of 2009
  

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:
	77 FR 800	01/06/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 24962	04/26/2012
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
ADAP site visit	1, 5, 2, 3, 4, 6, 7	Local ADAP Director/Lead ,   Medicaid Lead ,   Local ADAP Staff ,   Part B Lead ,   Pharmacy Benefit Management Representative ,   State PAP Administrator ,   Insurance Exchange and State Plan Administrators

---

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.

---

Annual Cost to Federal Government: $403,253

Does this IC contain surveys, censuses, or employ statistical methods? No

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

---

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: 05/08/2012

---