Evaluation of the Children?s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Quality Demonstration Grant Program: Qualitative Data Collection

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form #8 Adolescent Focus Groups	Form and Instruction	New	Repair queued
Form Form #7 Adolescent Focus Group Screener	Form and Instruction	New	Repair queued
Form Form #6 Parent Focus Groups	Form and Instruction	New	Repair queued
Form Form #5 Parent Focus Group Screener	Form and Instruction	New	Repair queued
Form Form #4 Health Care Provider Interviews	Form and Instruction	New	Repair queued
Form Form #3 Stakeholder Interviews	Form and Instruction	New	Repair queued
Form Form #2 Implementation Staff Interviews	Form and Instruction	New	Repair queued
Form Form #1 Key Staff Interviews	Form and Instruction	New	Repair queued
SS Part B -- Eval of 2009 CHIPRA - Qualitative Data Collection 7-23-2013.docx	Supporting Statement B	Uploaded 2013-11-06	Repair queued
Attachment Q- Confidentiality Pledge.docx	Supplementary Document	Uploaded 2013-11-06	Repair queued
Attachment P- Provider Site Recruitment Letters.docx	Supplementary Document	Uploaded 2013-11-06	Repair queued
Attachment O - Technical Expert Panel Members.docx	Supplementary Document	Uploaded 2013-11-06	Repair queued
Attachment N -- Federal Register Notice.pdf	Supplementary Document	Uploaded 2013-11-06	Repair queued
Attachment J- Informed Consent Forms.docx	Supplementary Document	Uploaded 2013-11-06	Repair queued
Attachment A - Authorizing Legislation.docx	Supplementary Document	Uploaded 2013-11-06	Repair queued
Attachment L- Adolescent Focus Group Recruitment Materials.docx	Supplementary Document	Uploaded 2013-11-06	Repair queued
Attachment H- Parent Focus Group Recruitment Materials.docx	Supplementary Document	Uploaded 2013-11-06	Repair queued
Attachment C- Interview Request and Confirmation Emails.docx	Supplementary Document	Uploaded 2013-11-06	Repair queued
Attachment C- Interview Request and Confirmation Emails.docx	Supplementary Document	Uploaded 2013-11-05	Repair queued
SS Part A -- Eval of 2009 CHIPRA - Qualitative Data Collection 7-23-2013.docx	Supporting Statement A	Uploaded 2013-11-06	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
209254	Adolescent Focus Groups	Form and Instruction	New
209253	Adolescent Focus Group Screener	Form and Instruction	New
209252	Parent Focus Groups	Form and Instruction	New
209251	Parent Focus Group Screener	Form and Instruction	New
209250	Health Care Provider Interviews	Form and Instruction	New
209249	Stakeholder Interviews	Form and Instruction	New
209248	Implementation Staff Interviews	Form and Instruction	New
209247	Key Staff Interviews	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 201311-0935-001
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No: 20863
Title: Evaluation of the Children?s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Quality Demonstration Grant Program: Qualitative Data Collection
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: Withdrawn	Conclusion Date: 03/24/2014
	Date Received in OIRA: 11/08/2013
Terms of Clearance: Withdrawn per agency request. Was resubmitted as a revision to an existing collection, which was also approved today, 3/24/2014.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		12 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 401(a) of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Pub. L. 111-3, amended the Social Security Act (the Act) to enact section 1139A (42 U.S.C. 1320b-9a). AHRQ is requesting approval from the Office of Management and Budget (OMB) for the collection of qualitative data through site visit interviews and focus groups to support a comprehensive, mixed-methods evaluation of the quality demonstration grants authorized under section 1139A(d) of the Act (Attachment A). AHRQ's mission of improving the quality and effectiveness of health care in the United States aligns with evaluating whether, and through what mechanism, projects funded by the CHIPRA demonstration grants improve the quality of care received by children in Medicaid and the Children's Health Insurance Program (CHIP).

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
  

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 46335	07/31/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 65318	10/31/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Key Staff Interviews	Form #1	Key Staff Interview Guide
Implementation Staff Interviews	Form #2	Implementation Staff Interview Guide
Stakeholder Interviews	Form #3	Stakeholder Interview Guide
Health Care Provider Interviews	Form #4	Health Care Organization Staff Interview Guide
Parent Focus Group Screener	Form #5	Parent Telephone Screening Script
Parent Focus Groups	Form #6	Parent Focus Group Protocol
Adolescent Focus Group Screener	Form #7	Adolescent Telephone Screening Script
Adolescent Focus Groups	Form #8	Adolescent Focus Group Protocol

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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 new information collection request.

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Annual Cost to Federal Government: $1,591,186

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: 11/08/2013

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