Understanding and Monitoring Funding Streams in Ryan White Clinics

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Understanding and Monitoring Funding Streams in Ryan White Clinics Survey	Form and Instruction	New	Available
Funding Streams Project_OMB Supporting Statement_Part B_2014 FINAL Revisions.docx	Supporting Statement B	Uploaded 2014-03-10	Available
Survey Implementation Materials.docx	Supplementary Document	Uploaded 2013-12-24	Available
IRB exemption.pdf	Supplementary Document	Uploaded 2013-12-24	Available
Funding Streams Project_OMB Supporting Statement_Part A_2014 Final Revisions.docx	Supporting Statement A	Uploaded 2014-03-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
209908	Understanding and Monitoring Funding Streams in Ryan White Clinics Survey	Form and Instruction	New

ICR Details

OMB Control No: 0915-0377	ICR Reference No: 201312-0915-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No: 21239
Title: Understanding and Monitoring Funding Streams in Ryan White Clinics
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 with change	Conclusion Date: 03/14/2014
	Date Received in OIRA: 12/31/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	36 Months From Approved
Responses	120	0	0
Time Burden (Hours)	564	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The proposed study will provide HAB and policymakers with a better understanding of how the RWHAP Part C and D grantees currently provide primary outpatient health care and essential support services to both uninsured and underinsured clients. The data collected will also help HAB understand the abilities of the grantees to support and track expanded health insurance enrollment for their clients and to adapt to the changing funding landscape.

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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 61367	10/03/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 79470	12/30/2013
Did the Agency receive public comments on this ICR? Yes

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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
Understanding and Monitoring Funding Streams in Ryan White Clinics Survey	1	Understanding and Monitoring Funding Streams in Ryan White Clinics 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	120	0	0	120	0	0
Annual Time Burden (Hours)	564	0	0	564	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 new information collection.

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Annual Cost to Federal Government: $698,053

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: 12/31/2013

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