Ryan White HIV/AIDS Program Allocation and Expenditure Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form D2 PartDExpendituresReport	Form	Modified	Available
Form D1 PartDAllocationsReport	Form	Modified	Available
Form C2 PartCExpendituresReport.	Form	Modified	Available
Form C1 PartCAllocationsReport	Form	Modified	Available
Form 4a Part B Allocations Report	Form	Removed	Available
Form 4b Part B Expenditures Report	Form	Removed	Available
Form B2 Part B Expenditures Report	Form	Modified	Available
Form B1 Part B MAI Allocations Report	Form	Modified	Available
Form 3 Part A Expenditures Report and Checklist	Form	Removed	Available
Form 2 Part A Allocations Report and Checklist	Form	Removed	Available
Form A2 Part A and MAI Allocations Table	Form	Modified	Available
Form A1 Part A and MAI Allocations Table	Form	Modified	Available
A - 2009 RWHAP Legislation.pdf	Supplementary Document	Uploaded 2014-02-11	Available
Attachment B List of Grantees Consulted on Burden Estimates.docx	Supplementary Document	Uploaded 2014-02-11	Available
Supporting Statement.doc	Supporting Statement A	Uploaded 2014-02-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
183276	Part D Allocation and Expenditure forms	Form	Modified	PartDExpendituresReport
183276	Part D Allocation and Expenditure forms	Form	Modified	PartDAllocationsReport
183275	Part C Allocation and Expenditure forms	Form	Modified	PartCExpendituresReport.
183275	Part C Allocation and Expenditure forms	Form	Modified	PartCAllocationsReport
183274	MAI Report for Part B	Form	Removed	Part B Allocations Report
183274	MAI Report for Part B	Form	Removed	Part B Expenditures Report
183274	MAI Report for Part B	Instruction	Removed
183273	Part B Allocation and Expenditure forms	Form	Modified	Part B Expenditures Report
183273	Part B Allocation and Expenditure forms	Form	Modified	Part B MAI Allocations Report
183272	MAI report for Part A	Form	Removed	Part A Expenditures Report and Checklist
183272	MAI report for Part A	Form	Removed	Part A Allocations Report and Checklist
183272	MAI report for Part A	Instruction	Removed
183271	Part A Allocation and Expenditures Forms	Form	Modified	Part A and MAI Allocations Table
183271	Part A Allocation and Expenditures Forms	Form	Modified	Part A and MAI Allocations Table

ICR Details

OMB Control No: 0915-0318	ICR Reference No: 201402-0915-002
Status: Historical Active	Previous ICR Reference No: 201102-0915-003
Agency/Subagency: HHS/HSA	Agency Tracking No: 21434
Title: Ryan White HIV/AIDS Program Allocation and Expenditure Forms
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: 03/25/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/14/2014
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	03/31/2014
Responses	1,146	0	1,362
Time Burden (Hours)	4,266	0	9,546
Cost Burden (Dollars)	0	0	0

---

Abstract: The Ryan White HIV/AIDS Treatment Modernization Act of 2006 requires grantees receiving funds under Parts A, B, and C to spend at least 75 percent of their grant funds on core medical services. Prior to the new law, no core set of medical services had been specified in the statute. The Allocation and Expenditure forms collect information necessary tn monitor grant funds and ensure compliance with the Act.

---

Authorizing Statute(s): PL: Pub.L. 109 - 415 1 Name of Law: Ryan White HIV/AIDS Treatment Modernization Act of 2006
   US Code: 42 USC 2601 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 75354	12/11/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 8200	02/11/2014
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
MAI Report for Part B	4b, 4a	Part B Expenditures Report ,   Part B Allocations Report
MAI report for Part A	2, 3	Part A Allocations Report and Checklist ,   Part A Expenditures Report and Checklist
Part A Allocation and Expenditures Forms	A1, A2	Part A and MAI Allocations Table ,   Part A and MAI Allocations Table
Part B Allocation and Expenditure forms	B1, B2	Part B MAI Allocations Report ,   Part B Expenditures Report
Part C Allocation and Expenditure forms	C1, C2	PartCAllocationsReport ,   PartCExpendituresReport.
Part D Allocation and Expenditure forms	D1, D2	PartDAllocationsReport ,   PartDExpendituresReport

---

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	1,146	1,362	0	-216	0	0
Annual Time Burden (Hours)	4,266	9,546	0	-5,280	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: No changes were made on the forms, however new burden estimates from grantees were collected and updated. Burden changes varied according to grantee experience and the financial systems used by grantees.

---

Annual Cost to Federal Government: $10,200

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

---

Common Form ICR:  No

---

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: 02/14/2014

---