Developmental Disabilities Program Independent Evaluation Project

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 19 UCEDD: Self-administered Form	Form and Instruction	Modified	Available
Form 18 UCEDD: Interview with Recipients of Community Services or Members of Organizations/Agencies that are Trained to Provide Community Services	Form	Modified	Available
Form 17 UCEDD: Interview with Peer Researchers and Colleagues	Form	Modified	Available
Form 16 UCEDD: Interview with the Consumer Advisory Committee	Form	Modified	Available
Form 15 UCEDD: Telephone Interview with Current and Graduated Students	Form	Modified	Available
Form 14 UCEDD: Interview with Director	Form	Modified	Available
Form 13 P&A: Self-administered Form	Form	Modified	Available
Form 12 P&A: Interview with Clients	Form	Modified	Available
Form 11 P&A: Interview with Recipient of Community Education	Form	Modified	Available
Form 10 P&A: Group Interview with Policymakers and Collaborators	Form	Modified	Available
Form 9 P&A: Board of Directors (Commissioners)-Chair and Members	Form	Modified	Available
Form 8 P&A: Staff Interview	Form	Modified	Available
Form 6 DD Council: Self-administered Form	Form and Instruction	Modified	Available
Form 7 P&A: Executive Director Interview	Form	Modified	Available
Form 5 DD Council: Group Interview with Recipients of Education and Training to Improve Community Capacity	Form	Modified	Available
Form 4 DD Council: Group Interview with Recipients of Self-Advocacy and Leadership Education and Training	Form	Modified	Available
Form 3 DD Council: Group Interview with Policymakers, Collaborators, and Grantees	Form	Modified	Repair queued
Form 2 Interview with DD Council	Form	Modified	Available
Form 1 DD Council Executive Director Interview	Form	Modified	Available
Supporting Statement Part B - 6-14-2011.docx	Supporting Statement B	Uploaded 2011-06-20	Available
Supporting Statement - Part A -6-14-2011 (2).doc	Supporting Statement A	Uploaded 2011-06-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
195747	Executive Director questionnaire for ADD Assessment	Other-Executive Director questionnaire for ADD Assessment	New
189891	UCEDD: Self-administered Form	Form and Instruction	Modified	UCEDD: Self-administered Form
189890	UCEDD: Interview with Recipients of Community Services or Members of Organizations/Agencies that are Trained to Provide Community Services	Form	Modified	UCEDD: Interview with Recipients of Community Services or Members of Organizations/Agencies that are Trained to Provide Community Services
189889	UCEDD: Interview with Peer Researchers and Colleagues	Form	Modified	UCEDD: Interview with Peer Researchers and Colleagues
189888	UCEDD: Interview with the Consumer Advisory Committee	Form	Modified	UCEDD: Interview with the Consumer Advisory Committee
189887	UCEDD: Telephone Interview with Current and Graduated Students	Form	Modified	UCEDD: Telephone Interview with Current and Graduated Students
189886	UCEDD: Interview with Director	Form	Modified	UCEDD: Interview with Director
189885	P&A: Self-administered Form	Form	Modified	P&A: Self-administered Form
189884	P&A: Interview with Clients	Form	Modified	P&A: Interview with Clients
189883	P&A: Interview with Recipient of Community Education	Form	Modified	P&A: Interview with Recipient of Community Education
189882	P&A: Group Interview with Policymakers and Collaborators	Form	Modified	P&A: Group Interview with Policymakers and Collaborators
189881	P&A: Board of Directors (Commissioners)-Chair and Members	Form	Modified	P&A: Board of Directors (Commissioners)-Chair and Members
189880	P&A: Staff Interview	Form	Modified	P&A: Staff Interview
189879	DDC Self-administered Form	Form and Instruction	Modified	DD Council: Self-administered Form
189878	P&A: Executive Director Interview	Form	Modified	P&A: Executive Director Interview
189877	DD Council: Group Interview with Recipients of Education and Training to Improve Community Capacity	Form	Modified	DD Council: Group Interview with Recipients of Education and Training to Improve Community Capacity
189876	DD Council: Group Interview with Recipients of Self-Advocacy and Leadership Education and Training	Form	Modified	DD Council: Group Interview with Recipients of Self-Advocacy and Leadership Education and Training
189875	DD Council: Group Interview with Policymakers, Collaborators, and Grantees	Form	Modified	DD Council: Group Interview with Policymakers, Collaborators, and Grantees
189874	Interview with DD Council Chair	Form	Modified	Interview with DD Council
189873	DD Council Executive Director Interview	Form	Modified	DD Council Executive Director Interview

ICR Details

OMB Control No: 0985-0031	ICR Reference No: 201205-0985-008
Status: Historical Active	Previous ICR Reference No: 200907-0970-002
Agency/Subagency: HHS/ACL	Agency Tracking No:
Title: Developmental Disabilities Program Independent Evaluation Project
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/25/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/25/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2013	36 Months From Approved
Responses	1,560	0	1,380
Time Burden (Hours)	4,255	0	4,075
Cost Burden (Dollars)	0	0	0

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Abstract: ADD is seeking OMB approval for evaluation tools designed to collect data to measure the programs' effectiveness and achievements according to indicators (structural, process, output, and outcome) in key function areas. The evaluation tools are primarily protocols for conducting interviews with various staff of the three programs and stakeholders associated with the programs. There is also a new, self-administered form for each of the programs to be completed by Executive Directors or their designees.

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Authorizing Statute(s): PL: Pub.L. 106 - 402 15 Name of Law: DDA Bill of Act of 2000
  

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:
	75 FR 33309	06/11/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 67977	11/04/2010
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 20

table that charts list of burden

IC Title	Form No.	Form Name
DD Council Executive Director Interview	1	DD Council Executive Director Interview
DD Council: Group Interview with Policymakers, Collaborators, and Grantees	3	DD Council: Group Interview with Policymakers, Collaborators, and Grantees
DD Council: Group Interview with Recipients of Education and Training to Improve Community Capacity	5	DD Council: Group Interview with Recipients of Education and Training to Improve Community Capacity
DD Council: Group Interview with Recipients of Self-Advocacy and Leadership Education and Training	4	DD Council: Group Interview with Recipients of Self-Advocacy and Leadership Education and Training
DDC Self-administered Form	6	DD Council: Self-administered Form
Executive Director questionnaire for ADD Assessment
Interview with DD Council Chair	2	Interview with DD Council
P&A: Board of Directors (Commissioners)-Chair and Members	9	P&A: Board of Directors (Commissioners)-Chair and Members
P&A: Executive Director Interview	7	P&A: Executive Director Interview
P&A: Group Interview with Policymakers and Collaborators	10	P&A: Group Interview with Policymakers and Collaborators
P&A: Interview with Clients	12	P&A: Interview with Clients
P&A: Interview with Recipient of Community Education	11	P&A: Interview with Recipient of Community Education
P&A: Self-administered Form	13	P&A: Self-administered Form
P&A: Staff Interview	8	P&A: Staff Interview
UCEDD: Interview with Director	14	UCEDD: Interview with Director
UCEDD: Interview with Peer Researchers and Colleagues	17	UCEDD: Interview with Peer Researchers and Colleagues
UCEDD: Interview with Recipients of Community Services or Members of Organizations/Agencies that are Trained to Provide Community Services	18	UCEDD: Interview with Recipients of Community Services or Members of Organizations/Agencies that are Trained to Provide Community Services
UCEDD: Interview with the Consumer Advisory Committee	16	UCEDD: Interview with the Consumer Advisory Committee
UCEDD: Self-administered Form	19	UCEDD: Self-administered Form
UCEDD: Telephone Interview with Current and Graduated Students	15	UCEDD: Telephone Interview with Current and Graduated Students

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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	1,560	1,380	0	180	0	0
Annual Time Burden (Hours)	4,255	4,075	0	180	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: A program change occurred with the addition of the Executive Director questionnaire. There were no adjustments. This change increased burden by 180 hours.

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Annual Cost to Federal Government: $770,442

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: 12/17/2010

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