Hepatitis Testing and Linkage to Care Monitoring and Evaluation System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Program-level Data	Form and Instruction	Modified	Available
Att4.3 ScreenShot - HEPTLC Data Collection HBV_HCV	Form and Instruction	Modified	Available
Att4.2 HCV- HEPTLC Data Collection Template	Form and Instruction	Modified	Available
Att4.1 HBV- HEPTLC Data Collection Template	Form and Instruction	Modified	Available
SuppState B Clean.doc	Supporting Statement B	Uploaded 2013-03-21	Available
Att9 970_AOC Approval_2012.pdf	Supplementary Document	Uploaded 2013-01-10	Available
Att8 RulesOfBehavior - Users.docx	Supplementary Document	Uploaded 2013-01-10	Available
Att7 RulesOfBehavior - Administrator.docx	Supplementary Document	Uploaded 2013-01-10	Available
Att6 Agencies and Persons Consulted.docx	Supplementary Document	Uploaded 2013-01-10	Available
Att3 Goals_Objectives Table.docx	Supplementary Document	Uploaded 2013-01-10	Available
Att2 60 Day FRN Published.PDF	Supplementary Document	Uploaded 2013-01-10	Available
Att1 Auth Legis.pdf	Supplementary Document	Uploaded 2013-01-10	Available
SuppState A Clean.doc	Supporting Statement A	Uploaded 2013-03-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
204800	Program-level Data	Form and Instruction	Modified	Program-level Data
204799	Test-level Data	Form and Instruction	Modified	Att4.3 ScreenShot - HEPTLC Data Collection HBV_HCV
204799	Test-level Data	Form and Instruction	Modified	Att4.2 HCV- HEPTLC Data Collection Template
204799	Test-level Data	Instruction	Modified
204799	Test-level Data	Form and Instruction	Modified	Att4.1 HBV- HEPTLC Data Collection Template

ICR Details

OMB Control No: 0920-0959	ICR Reference No: 201301-0920-006
Status: Historical Active	Previous ICR Reference No: 201211-0920-007
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Hepatitis Testing and Linkage to Care Monitoring and Evaluation System
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: 03/22/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/17/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2016	36 Months From Approved
Responses	640	0	0
Time Burden (Hours)	6,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Hepatitis Testing and Linkage to Care Monitoring and Evaluation System is a web-bsed data system to collect standardized, non-identifying, client- and test-level hepatitis testing information from funded testing sites. The data will be used to monitor and evaluate the implementation of hepatitis testing and linkage to care activities and to collect and report on required program performance indicators.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
  

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 34952	06/12/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 65553	10/29/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Program-level Data	none	Program-level Data
Test-level Data	none, none, none	Att4.1 HBV- HEPTLC Data Collection Template ,   Att4.2 HCV- HEPTLC Data Collection Template ,   Att4.3 ScreenShot - HEPTLC Data Collection HBV_HCV

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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	640	0	0	640	0	0
Annual Time Burden (Hours)	6,000	0	0	6,000	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 ICR.

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Annual Cost to Federal Government: $563,279

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: 01/17/2013

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