Evaluation of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Quality Demonstration Grant Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 15 Adolescent Pre-Focus Group Interview Script	Form and Instruction	New	Available
Form 14 Adolescent Telephone Screening Script	Form and Instruction	New	Available
Form 13 Adolescent Focus Group Protocol	Form and Instruction	New	Available
Form 12 Parent Pre-Focus Group Interview Script	Form and Instruction	New	Available
Form 11 Parent Telephone Screening Script	Form and Instruction	New	Available
Form 10 2014 Parent Focus Group Protocol	Form and Instruction	New	Available
Form Form #5 Other States Interview Guide	Form and Instruction	Removed	Available
Form 9 2014 Health Care Organization Staff Interview Guide	Form and Instruction	Modified	Available
Form 8 2012 Health Care Organization Staff Interview Guides	Form and Instruction	Modified	Available
Form 5 2014 Stakeholder Interview Guide	Form and Instruction	Modified	Available
Form 4 2012 Stakeholder Interview Guides	Form and Instruction	Modified	Available
Form 3 2014 Implementation Staff Interview Guide	Form and Instruction	Modified	Available
Form 2 2012 Implementation Staff Interview Guide	Form and Instruction	Modified	Available
Form 1 2014 Key Staff Interview Guide	Form and Instruction	Modified	Repair queued
Form Form #1 Key Staff Interview Guide	Form and Instruction	Modified	Available
CHIPRASupporting Statement Part B -- Revised Feb 14 2014.docx	Supporting Statement B	Uploaded 2014-02-19	Available
Attachment A - Authorizing Legislation.docx	Supplementary Document	Uploaded 2014-02-19	Available
Attachment X- Confidentiality Pledge.docx	Supplementary Document	Uploaded 2014-02-19	Available
Attachment W- Provider Site Recruitment Letters 7-23-2013.docx	Supplementary Document	Uploaded 2014-02-19	Available
Attachment V - Technical Expert Panel Members.docx	Supplementary Document	Uploaded 2014-02-19	Available
Attachment T- CHIPRA Quality Demonstration Evaluation Research Questions.docx	Supplementary Document	Uploaded 2014-02-19	Available
Attachment Q- 2014 Adolescent Focus Group Recruitment Materials.docx	Supplementary Document	Uploaded 2014-02-19	Available
Attachment Q- 2014 Adolescent Focus Group Recruitment Materials.docx	Supplementary Document	Uploaded 2014-02-19	Available
Attachment Q- 2014 Adolescent Focus Group Recruitment Materials.docx	Supplementary Document	Uploaded 2014-02-19	Available
Attachment O- Informed Consent Forms.docx	Supplementary Document	Uploaded 2014-02-19	Available
Attachment L- 2014 Parent Focus Group Recruitment Materials.docx	Supplementary Document	Uploaded 2014-02-19	Available
Attachment L- 2014 Parent Focus Group Recruitment Materials.docx	Supplementary Document	Uploaded 2014-02-19	Available
Attachment L- 2014 Parent Focus Group Recruitment Materials.docx	Supplementary Document	Uploaded 2014-02-19	Available
Attachment O- Informed Consent Forms.docx	Supplementary Document	Uploaded 2014-02-19	Available
Attachment C- Interview Request and Confirmation Emails.docx	Supplementary Document	Uploaded 2014-02-18	Available
Attachment C- Interview Request and Confirmation Emails.docx	Supplementary Document	Uploaded 2014-02-18	Available
Attachment C- Interview Request and Confirmation Emails.docx	Supplementary Document	Uploaded 2014-02-18	Available
Attachment C- Interview Request and Confirmation Emails.docx	Supplementary Document	Uploaded 2014-02-18	Available
CHIPRASupporting Statement Part A -- Revised Feb 14 2014.docx	Supporting Statement A	Uploaded 2014-02-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210514	Adolescent Pre-Focus Group Interview Script	Form and Instruction	New	Adolescent Pre-Focus Group Interview Script
210513	Adolescent Telephone Screening Script	Form and Instruction	New	Adolescent Telephone Screening Script
210512	Adolescent Focus Group Protocol	Form and Instruction	New	Adolescent Focus Group Protocol
210511	Parent Pre-Focus Group Interview Script	Form and Instruction	New	Parent Pre-Focus Group Interview Script
210510	Parent Telephone Screening Script	Form and Instruction	New	Parent Telephone Screening Script
210509	Parent Focus Group Protocol	Form and Instruction	New	2014 Parent Focus Group Protocol
199924	Non-demonstration States Interviews	Form and Instruction	Removed	Other States Interview Guide
199923	Health Care Provider Interviews	Form and Instruction	Modified	2014 Health Care Organization Staff Interview Guide
199923	Health Care Provider Interviews	Form and Instruction	Modified	2012 Health Care Organization Staff Interview Guides
199922	Stakeholder Interviews	Form and Instruction	Modified	2014 Stakeholder Interview Guide
199922	Stakeholder Interviews	Form and Instruction	Modified	2012 Stakeholder Interview Guides
199921	Implementation Staff Interviews	Form and Instruction	Modified	2014 Implementation Staff Interview Guide
199921	Implementation Staff Interviews	Form and Instruction	Modified	2012 Implementation Staff Interview Guide
199920	Key Staff Interviews	Form and Instruction	Modified	2014 Key Staff Interview Guide
199920	Key Staff Interviews	Form and Instruction	Modified	Key Staff Interview Guide

ICR Details

OMB Control No: 0935-0190	ICR Reference No: 201402-0935-001
Status: Historical Active	Previous ICR Reference No: 201110-0935-003
Agency/Subagency: HHS/AHRQ	Agency Tracking No: 21456
Title: Evaluation of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Quality Demonstration Grant 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: 03/24/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/25/2014
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	02/28/2015
Responses	1,838	0	837
Time Burden (Hours)	1,954	0	855
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 to extend and revise a currently approved qualitative study to evaluate the children's health care quality demonstration grants authorized under section 1139A(d) of the Act. The first round of qualitative data collection (OMB# 0935-0190) was approved by the Office of Management and Budget with an expiration date of February 28, 2015. Key informant interviews conducted during the first round of qualitative data collection provided information on early demonstration strategies and lessons learned by the demonstration States during the first two years of their grant projects. This revised information collection request seeks approval to: (1) conduct a second round of key informant interviews; and (2) conduct parent and adolescent focus groups in demonstration States. Evaluating whether the CHIPRA demonstration grants improve the quality of care received by children in Medicaid and CHIP aligns with AHRQ's mission of improving the quality and effectiveness of health care in the United States.

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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: 10

table that charts list of burden

IC Title	Form No.	Form Name
Adolescent Focus Group Protocol	13	Adolescent Focus Group Protocol
Adolescent Pre-Focus Group Interview Script	15	Adolescent Pre-Focus Group Interview Script
Adolescent Telephone Screening Script	14	Adolescent Telephone Screening Script
Health Care Provider Interviews	8, 9	2012 Health Care Organization Staff Interview Guides ,   2014 Health Care Organization Staff Interview Guide
Implementation Staff Interviews	2, 3	2012 Implementation Staff Interview Guide ,   2014 Implementation Staff Interview Guide
Key Staff Interviews	Form #1, 1	Key Staff Interview Guide ,   2014 Key Staff Interview Guide
Non-demonstration States Interviews	Form #5	Other States Interview Guide
Parent Focus Group Protocol	10	2014 Parent Focus Group Protocol
Parent Pre-Focus Group Interview Script	12	Parent Pre-Focus Group Interview Script
Parent Telephone Screening Script	11	Parent Telephone Screening Script
Stakeholder Interviews	4, 5	2012 Stakeholder Interview Guides ,   2014 Stakeholder Interview Guide

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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	1,838	837	0	1,001	0	0
Annual Time Burden (Hours)	1,954	855	0	1,099	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: Under the revised information collection request, we are requesting to conduct a second round of interviews with all interview respondents as well as a round of focus groups. Therefore, the number of responses per respondent increased from one to two for interview respondents, and burden hours were added to account for focus group recruitment and participation. In the original information collection request, we requested to conduct follow up telephone interviews with key informant staff and telephone interviews with staff in non demonstration States. We did not collect this information, and those hours are no longer included in the burden estimates.

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Annual Cost to Federal Government: $1,651,662

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)? Yes

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: 02/25/2014

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