Evaluation of Implementation of the Viral Hepatitis Action Plan

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0990-Evaluation of Viral Hepatitis Section B Statistical Methods_BTL_3 05 13.doc	Supporting Statement B	Uploaded 2013-03-05	Available
18521_0990-ViralHepatitis-9 IRB Approval Letter BTL.pdf	Supplementary Document	Uploaded 2013-03-28	Available
18521_ID-ViralHepatitis- 1 Email Contact Script.docx	Supplementary Document	Uploaded 2013-03-28	Available
18521_ID 0990-Evaluation of Implementation of Viral Hepatitis Action Plan.docx	Supporting Statement A	Uploaded 2013-03-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206339	Healthcare providers	Other-guide	New
206338	Correctional Facilities	Other-guide	New
206337	National Organizations	Other-guide	New
206336	Community-based organizations	Other-guide	New
206335	State and Local Health Departments	Other-interview guide	New
206334	Audlt Viral Hepatitis Prevention Coordinators	Other-guide	New

ICR Details

OMB Control No: 0990-0408	ICR Reference No: 201304-0990-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No: 18521
Title: Evaluation of Implementation of the Viral Hepatitis Action Plan
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: 05/22/2013
	Date Received in OIRA: 04/02/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2014	36 Months From Approved
Responses	68	0	0
Time Burden (Hours)	42	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the evaluation is to help HHS better understand local implementation of the Action Plan at the state and local level and any barriers or challenges that might be occurring. The results will enable HHS to identify potential strategies to strengthen local implementation of the Action Plan, address barriers, and inform future implementation efforts to help improve viral hepatitis prevention, care and treatment.

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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:
	78 FR 10619	02/14/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 19709	04/02/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Audlt Viral Hepatitis Prevention Coordinators
State and Local Health Departments
Community-based organizations
National Organizations
Correctional Facilities
Healthcare providers

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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	68	0	0	68	0	0
Annual Time Burden (Hours)	42	0	0	42	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: $271,448

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: 04/02/2013

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