Sickle Cell Disease Treatment Demonstration Program QI Measures

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Sickle Cell Disease Treatment Demonstration Program - Quality Improvement Data Collection for the Hemoglobinopathy Learning Collaborative	Form	New	Available
Appendix F and G_ SCDTDP expert panel members and TWG tables.pdf	Supplementary Document	Uploaded 2012-10-23	Available
Appendix B Measure Bank.pdf	Supplementary Document	Uploaded 2012-10-23	Available
Appendix A PLAW-108publ357_ACA2004_Section712.pdf	Supplementary Document	Uploaded 2012-10-23	Available
Supporting Statement.docx	Supporting Statement A	Uploaded 2012-10-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
204731	Sickle Cell Disease Treatment Demonstration Program - Quality Improvement Data Collection for the Hemoglobinopathy Learning Collaborative	Form	New

ICR Details

OMB Control No: 0915-0359	ICR Reference No: 201211-0915-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Sickle Cell Disease Treatment Demonstration Program QI Measures
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 without change	Conclusion Date: 03/20/2013
	Date Received in OIRA: 11/06/2012
Terms of Clearance: At the time of the next submission, HRSA should provide an update of how it has used the QI measures.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2016	36 Months From Approved
Responses	324	0	0
Time Burden (Hours)	2,700	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the quality improvement data collection strategy is to measure progress in meeting the goals of the Sickle Cell Disease Treatment and Demonstration Program (SCDTDP) and to implement a system to monitor the progress of HRSA's Maternal and Child Health Bureau (MCHB) funded activities in improving care and health outcomes for individuals living with sickle cell disease and sickle cell trait.

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Authorizing Statute(s): PL: Pub.L. 108 - 357 712 Name of Law: American Jobs Creation Act of 2004
  

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:
	77 FR 32127	05/31/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 66470	11/05/2012
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
Sickle Cell Disease Treatment Demonstration Program - Quality Improvement Data Collection for the Hemoglobinopathy Learning Collaborative	1, 2, 3	Participant Profile ,   Acute Care Visit ,   Ambulatory Care Visit

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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	324	0	0	324	0	0
Annual Time Burden (Hours)	2,700	0	0	2,700	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: This is a new data collection.

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Annual Cost to Federal Government: $164,315

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

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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: 11/06/2012

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