Health Profession Opportunity Grants (HPOG) program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
HPOG-ISIS Questions by Research Obj 7 26 13.xlsx	Supplementary Document	Uploaded 2013-08-07	Available
HPOG NIE and Impact Supporting Statement_Part B 4 24 13 revised 7 26 13_rev 8.7.13.docx	Supporting Statement B	Uploaded 2013-08-07	Available
HPOG Appendix L Consent Forms for Participant Surveys 5-2.pdf	Supplementary Document	Uploaded 2013-05-02	Available
HPOG Appendix P HPOG-Impact and HPOG-NIE Advance letter.docx	Supplementary Document	Uploaded 2013-04-30	Available
HPOG Appendix O Tracking Letter and Contact Update form.docx	Supplementary Document	Uploaded 2013-04-30	Available
HPOG Appendix N Previously Approved Supplementary Documents.pdf	Supplementary Document	Uploaded 2013-04-30	Available
HPOG Appendix M Information on the Full ISIS Sample Frame.docx	Supplementary Document	Uploaded 2013-04-30	Available
HPOG Appendix A HPOG Logic Model.docx	Supplementary Document	Uploaded 2013-04-30	Available
HPOG NIE and Impact Supporting Statement_Part A 4 24 13 revised 7 26 13 v2.docx	Supporting Statement A	Uploaded 2013-08-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206801	HPOG-NIE 15-month Participant Follow-Up survey	Other-Survey	New
206800	HPOG-Impact 15-month Control Group Member Follow-Up survey	Other-Survey	New
206799	HPOG-Impact 15-month Participant Follow-Up survey	Other-Survey	New
206798	HPOG-NIE Employer survey	Other-Survey	New
206797	HPOG-NIE Stakeholder/Network survey	Other-Survey	New
206796	HPOG-NIE Management and Staff survey	Other-Survey	New
206795	HPOG-Impact Implementation interview guide for HPOG program staff	Other-Interview Guide	New
206794	HPOG-Impact Implementation interview guide for HPOG program management	Other-Interview Guide	New
206793	HPOG-Impact Implementation interview guide for instructors	Other-Interview Guide	New
206792	HPOG-Impact Implementation interview guide for partnering employers	Other-Interview Guide	New
206791	HPOG-NIE Grantee survey	Other-Survey	New
206790	HPOG-NIE Follow-Up Phone Call Protocol for the Stakeholder/Network survey	Other-Questionnaire	New
206789	HPOG-NIE Sampling Questionnaire for the HPOG surveys	Other-Questionnaire	New
202865	Supplemental Baseline Questions (grantees)	Other-Supplemental Questions	Modified
202864	Supplemental Baseline Questions (program participants and control group members)	Other-Supplemental Questions	Modified
198341	Semi-annual HPOG Program Performance Report	Other-Word	Modified

ICR Details

OMB Control No: 0970-0394	ICR Reference No: 201305-0970-001
Status: Historical Active	Previous ICR Reference No: 201206-0970-010
Agency/Subagency: HHS/ACF	Agency Tracking No: 19416
Title: Health Profession Opportunity Grants (HPOG) program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/12/2013
	Date Received in OIRA: 05/07/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2016	24 Months From Approved	10/31/2014
Responses	15,929	0	10,314
Time Burden (Hours)	8,212	0	4,559
Cost Burden (Dollars)	0	0	0

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Abstract: ACF is implementing a multi-pronged research and evaluation approach for the HPOG program to better understand and assess the activities conducted and their results. The current submission is in support of the HPOG National Implementation Evaluation (NIE) and the HPOG Impact Study. Together, HPOG-NIE and HPOG-Impact will collect data to document and demonstrate how effectively grantees implement the HPOG program and to assess how variations in program services affect program outcomes and impacts. As such, HPOG-NIE and HPOG-Impact will fill a void in the sectoral training and career pathways literature both about program effectiveness and about which types of programs or program components are most effective.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 5507 Name of Law: Patient Protection and Affordable Care 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 75437	12/20/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 26373	05/06/2013
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 16

table that charts list of burden

IC Title	Form No.	Form Name
Semi-annual HPOG Program Performance Report
Supplemental Baseline Questions (program participants and control group members)
Supplemental Baseline Questions (grantees)
HPOG-NIE Sampling Questionnaire for the HPOG surveys
HPOG-NIE Follow-Up Phone Call Protocol for the Stakeholder/Network survey
HPOG-NIE Grantee survey
HPOG-Impact Implementation interview guide for partnering employers
HPOG-Impact Implementation interview guide for instructors
HPOG-Impact Implementation interview guide for HPOG program management
HPOG-Impact Implementation interview guide for HPOG program staff
HPOG-NIE Management and Staff survey
HPOG-NIE Stakeholder/Network survey
HPOG-NIE Employer survey
HPOG-Impact 15-month Participant Follow-Up survey
HPOG-Impact 15-month Control Group Member Follow-Up survey
HPOG-NIE 15-month Participant Follow-Up survey

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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	15,929	10,314	0	5,615	0	0
Annual Time Burden (Hours)	8,212	4,559	0	3,653	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 request to add additional questions to an already approved collection.

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Annual Cost to Federal Government: $3,853,411

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]? 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: 05/06/2013

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