OS Think Cultural Health

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0990-TCH Supporting Statement 5_2_12FinalGP.doc	Supporting Statement A	Uploaded 2013-03-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
205362	other	Other-instrument	New
205361	Student	Other-instrument	New
205360	Doctorate	Other-instrument	New
205359	Masters	Other-instrument	New
205358	Bachelors	Other-instrument	New
205357	Lawyer	Other-instrument	New
205356	Teacher	Other-instrument	New
205355	Policymaker or Public Official	Other-instrument	New
205354	Administrator or Hospital Executive	Other-instrument	New
205353	Emergency Medical Technician	Other-instrument	New
205352	Pharmacist, RPH	Other-instrument	New
205351	Mental Health Professional	Other-instrument	New
205350	Psycologist/Psychiatrist	Other-instrument	New
205349	General Healthcare Worker	Other-instrument	New
205348	public Health	Other-instrument	New
205347	Social Worker	Other-instrument	New
205346	Dental Professional	Other-instrument	New
205345	Dentist	Other-instrument	New
205344	Physician Assistant	Other-instrument	New
205343	Nurse	Other-instrument	New
205342	Physician	Other-form	New

ICR Details

OMB Control No: 0990-0407	ICR Reference No: 201301-0990-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: OS Think Cultural Health
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: 04/01/2013
	Date Received in OIRA: 01/11/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2016	36 Months From Approved
Responses	118,692	0	0
Time Burden (Hours)	5,936	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Office of Minority Health (OMH), Office of the Secretary (OS), Department of Health and Human Services (HHS) is requesting approval from OMB for the registration component of the Think Cultural Health (TCH) website program. The TCH website is used to post information such as cultural competency, language access and health disparities articles, and notices of health disparities conferences for visitors to the site. Users must be registered to participate.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 5307 Name of Law: Patient Protection and Affordable Care Act of 2010
  

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 42499	07/19/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 61404	10/09/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 21

table that charts list of burden

IC Title	Form No.	Form Name
Physician
Nurse
Physician Assistant
Dentist
Dental Professional
Social Worker
public Health
General Healthcare Worker
Psycologist/Psychiatrist
Mental Health Professional
Pharmacist, RPH
Emergency Medical Technician
Administrator or Hospital Executive
Policymaker or Public Official
Teacher
Lawyer
Bachelors
Masters
Doctorate
Student
other

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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	118,692	0	0	118,692	0	0
Annual Time Burden (Hours)	5,936	0	0	5,936	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: New

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Annual Cost to Federal Government: $5,000

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? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

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: 01/11/2013

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