Healthy Start Evaluation and Quality Assurance

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3 Community Action Network (CAN) Survey	Form and Instruction	New	Available
Form 1 The Preconception, Pregnancy and Parenting (3P's) Information Form	Form	New	Available
Form 2 National Healthy Start Program Survey (NHSPS)	Form and Instruction	Modified	Repair queued
Supporting Statement B.docx	Supporting Statement B	Uploaded 2014-04-22	Available
Supporting Statement A.docx	Supporting Statement A	Uploaded 2014-04-22	Available
I. Matching Variables.docx	Supplementary Document	Uploaded 2014-04-15	Available
H. Pretest Results.docx	Supplementary Document	Uploaded 2014-04-15	Available
B. Benchmarks.docx	Supplementary Document	Uploaded 2014-04-15	Available
A. Healthy Start Reauthorization Act of 2007.pdf	Supplementary Document	Uploaded 2014-04-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
211291	Healthy Start Focus Group Protocol	Instruction	New
211290	Healthy Start Site Visit Protocol	Instruction	New
211289	Community Action Network (CAN) Survey	Form and Instruction	New
211288	The Preconception, Pregnancy and Parenting (3P's) Information Form	Form	New
195559	National Healthy Start Program Survey (NHSPS)	Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0338	ICR Reference No: 201404-0915-007
Status: Historical Active	Previous ICR Reference No: 201012-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Healthy Start Evaluation and Quality Assurance
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: 06/03/2014
	Date Received in OIRA: 04/22/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2017	36 Months From Approved	06/30/2014
Responses	41,183	0	102
Time Burden (Hours)	20,953	0	408
Cost Burden (Dollars)	0	0	0

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Abstract: HRSA/MCHB seeks to conduct a mixed-methods evaluation to assess the effectiveness of the Healthy Start program on individual, organizational, and community-level outcomes. The information collected will be used to obtain consistent information across all grantees about Healthy Start (HS) and its outcomes and in-depth information for 15 HS communities and 15 comparison communities to support a rigorous evaluation design. Respondents include pregnant women and women of reproductive age that were served by HS, HS staff and select HS partners.

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Authorizing Statute(s): PL: Pub.L. 101 - 239 501 Name of Law: Maternal and Child Health Services Block Grant
   PL: Pub.L. 110 - 339 122 Name of Law: Healthy Start Reauthorization
   US Code: 42 USC 201 Name of Law: Public Health Service 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:
	79 FR 4476	01/28/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 22504	04/22/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
National Healthy Start Program Survey (NHSPS)	2	National Healthy Start Program Survey (NHSPS)
The Preconception, Pregnancy and Parenting (3P's) Information Form	1	The Preconception, Pregnancy and Parenting (3P’s) Information Form
Healthy Start Focus Group Protocol
Community Action Network (CAN) Survey	3	Community Action Network (CAN) Survey
Healthy Start Site Visit Protocol

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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	41,183	102	0	41,081	0	0
Annual Time Burden (Hours)	20,953	408	0	20,545	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: This is a revision to the existing data collection activity for Healthy Start. The purpose of the changes/adjustments was to decrease burden, standardize data collection, and capture individual level data. These changes will improve the quality of data that can be used to monitor and assess the association between program components and outcomes. The National Healthy Start Program Survey was modified to decrease the amount of time it takes grantees to complete the survey and to improve question clarity. The 3Ps form was developed to capture individual-level or program participant information that will allow grantees to perform real-time internal analysis and the Maternal and Child Health Bureau (MCHB), Division of Healthy Start Program Services (DHSPS) to pool data and get a snapshot of implementation and outcomes at both the national and project levels. The Healthy Start Community Action Network (CAN) Survey was developed and designed to collect data needed to accurately measure the size and strength of the organizational networks in the Healthy Start community. In turn, this will provide important information on the extent to which Healthy Start and other community organizations are working together to achieve common goals.

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Annual Cost to Federal Government: $1,024,086

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: 04/22/2014

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