Alzheimer's Disease Supportive Services Program (ADSSP) Data Collection

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
2 of 3 ADSSP Definitions for Data Collection.doc	Supplementary Document	Uploaded 2010-05-20	Available
Draft ADSSP_OMB Data Supporting Statement_6_19_2013.docx	Supporting Statement A	Uploaded 2013-09-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
178976	Alzheimer's Disease Supportive Services Program (ADSSP) Data Collection	Other-fillable spreadsheet	Modified

ICR Details

OMB Control No: 0985-0022	ICR Reference No: 201309-0985-001
Status: Historical Active	Previous ICR Reference No: 201006-0985-001
Agency/Subagency: HHS/ACL	Agency Tracking No: 20468
Title: Alzheimer's Disease Supportive Services Program (ADSSP) Data Collection
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/02/2013
	Date Received in OIRA: 09/12/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2016	36 Months From Approved
Responses	94	0	0
Time Burden (Hours)	1,410	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Alzheimer's Disease Supportive Services Program (ADSSP) was established under Section 398 of the Public Health Service Act (P.L. 78-410; 42 U.S.C. 280c-3). It was amended by the Home Health Care and Alzheimer's Disease Amendments of 1990 (PL 101-557) and by the Health Professions Education Partnerships Act of 1998 (PL 105-392). The ADSSP is administered by the Administration on Aging (AoA) within the U.S. Department of Health and Human Services. The ADSSP program helps states extend supports and services to persons with dementia and their family caregivers, with a focus on underserved populations. The PHS Act requires AoA to "provide for an evaluation of each demonstration project for which a grant is made." In compliance with the PHS Act, AoA developed a new State data collection protocol that will require future ADSSP state grantees (those funded starting in FY 2011) to transmit semi-annual data to AoA. In December 2009, AoA initiated a review of the current ADSSP-Data Reporting Tool (ADSSP-DRT) to ensure the acceptability of these items for evaluating the program and minimizing burden for respondents. This review included experts in the field of Alzheimer's disease and long-term care who are familiar with the program, as well as current ADSSP grantees. Feedback was provided by phone and e-mail over a period of 4 months. The result of this input is the revised ADSSP-DRT and supporting documents. As with the current ADSSP-DRT, AoA will work with ADSSP grantees to ensure easy access to a reporting system and offer regular training in using the tool to ensure minimal burden for program grantees.

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Authorizing Statute(s): PL: Pub.L. 101 - 557 398 399 399A Name of Law: Home Health Care and Alzheimer's Disease Amendment of 1990
   PL: Pub.L. 78 - 410 398 Name of Law: Public Health Service Act
   PL: Pub.L. 105 - 392 302 Name of Law: Health Professions Education Partnerships 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:
	78 FR 36192	06/17/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 54254	09/03/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Alzheimer's Disease Supportive Services Program (ADSSP) Data Collection

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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	94	0	0	0	0	94
Annual Time Burden (Hours)	1,410	0	0	0	0	1,410
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $22,288

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? 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: 09/12/2013

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