AoA Title VI Program Peformance Report

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Supporting Statement for Title VI PR.docx	Supporting Statement A	Uploaded 2012-05-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43737	Program Performance Report, Title VI of the Older Americans Act (Grants for Native Americans for Nutritional and Supportive Services)	Other-Program Performance Report	Modified

ICR Details

OMB Control No: 0985-0007	ICR Reference No: 201205-0985-002
Status: Historical Active	Previous ICR Reference No: 200907-0985-001
Agency/Subagency: HHS/ACL	Agency Tracking No:
Title: AoA Title VI Program Peformance Report
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/02/2012
	Date Received in OIRA: 05/09/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2015	36 Months From Approved	08/31/2012
Responses	256	0	246
Time Burden (Hours)	640	0	615
Cost Burden (Dollars)	270	0	270

---

Abstract: Monitor program operations, growth and results of Title VI funded activities, provide information for responses to inquiries.

---

Authorizing Statute(s): PL: Pub.L. 109 - 365 202(a)(19) Name of Law: Functions of the Assistant Secretary
   PL: Pub.L. 109 - 365 202(a)(16)(A)(i)(ii)(iii) Name of Law: Functions of the Assistant Secretary
   PL: Pub.L. 109 - 365 207(a) Name of Law: Administration of the Act - Reports
   PL: Pub.L. 109 - 365 373(e)(3) Name of Law: Quality Standards and Mechanisms of Accountability - Reports
   PL: Pub.L. 109 - 365 614(a)(3) Name of Law: Part A - Indian Program Findings Applications
   PL: Pub.L. 109 - 365 624(a)(4) Name of Law: Part B - Native Hawaiian Program Findings - Applications
   US Code: 45 USC 92.40(b)(1) Name of Law: Monitoring and Reporting Program Performance
   US Code: 45 USC 1326.7 Name of Law: Confidentiality and Disclosure of Information
   PL: Pub.L. 109 - 365 208 Name of Law: Joint Funding of Projects
   US Code: 45 USC 1328.7 Name of Law: Confidentiality and Disclosure of Information
   PL: Pub.L. 109 - 365 623 Name of Law: Part B Native Hawaiian Grants Authorized
   PL: Pub.L. 109 - 365 631 Name of Law: Part C Native American Caregiver Support Program
   PL: Pub.L. 109 - 365 613 Name of Law: Part A Indian Grants Authorized
  

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 4044	01/26/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 13337	03/06/2012
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Program Performance Report, Title VI of the Older Americans Act (Grants for Native Americans for Nutritional and Supportive Services)

---

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	256	246	0	0	10	0
Annual Time Burden (Hours)	640	615	0	0	25	0
Annual Cost Burden (Dollars)	270	270	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $15,573

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: 05/09/2012

---