Process Evaluation of the National Partnership for Action to End Health Disparities

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
National Partnership Action OMB Supporting Statement Section B.docx	Supporting Statement B	Uploaded 2013-02-15	Available
National Partnership for Action OMB Supporting Statement Section A.docx	Supporting Statement A	Uploaded 2013-02-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
205846	State Minority Health Office Directors/Coordinators and State Department of Health Representatives	Other-form	New
205845	Key NPA partner organizations	Other-form	New
205844	RHEC Members	Other-forms	New
205843	RHEC Subcommittee chairs group interviews	Other-interview	New
205842	RHEC co-chairs interview	Other-interview	New

ICR Details

OMB Control No: 0990-0406	ICR Reference No: 201302-0990-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No: 17378
Title: Process Evaluation of the National Partnership for Action to End Health Disparities
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: 04/01/2013
	Date Received in OIRA: 02/19/2013
Terms of Clearance: Approved with the understanding that this is a process evaulation and not an outcome evaluation. OMH will not be able to draw conclusions about the effectiveness of the NPA or the NSS on health disparities. Screenshots of the web-based surveys must be submitted for approval prior to the start of data collection (this can be done through a non-substantive change).

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2016	36 Months From Approved
Responses	545	0	0
Time Burden (Hours)	263	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The data to be collected will be used to inform the various stakeholders involved in implementation of the NPA and the National Stakeholder Strategy about progress, results, lessons learned, and necessary mid-course adjustments.

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Authorizing Statute(s): None

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 59399	09/27/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 76488	12/28/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
RHEC co-chairs interview
RHEC Subcommittee chairs group interviews
RHEC Members
Key NPA partner organizations
State Minority Health Office Directors/Coordinators and State Department of Health Representatives

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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	545	0	0	545	0	0
Annual Time Burden (Hours)	263	0	0	263	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 collection

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Annual Cost to Federal Government: $62,264

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: 02/19/2013

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