Evaluation of Tribal Health Profession Opportunity Grants

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Attachment A11_Focus Group Recruitment Flyer.doc	Supplementary Document	Uploaded 2011-10-17	Available
Attachment A10_Telephone Interview Recruitment Letter.doc	Supplementary Document	Uploaded 2011-10-17	Available
Attachment A9_Focus Group Recruitment Letter.doc	Supplementary Document	Uploaded 2011-10-17	Available
Attachment A8_Administrative Staff, Implementation Staff, Employers Recruitment Letter.doc	Supplementary Document	Uploaded 2011-10-17	Repair queued
Attachment A7_Grantee Advance Letter.doc	Supplementary Document	Uploaded 2011-10-17	Available
Attachment A6_NORC IRB Approval.doc	Supplementary Document	Uploaded 2011-10-17	Repair queued
Attachment A5_Focus Group Informed Consent Form.doc	Supplementary Document	Uploaded 2011-10-17	Available
Attachment A4_Interview Informed Oral Consent.doc	Supplementary Document	Uploaded 2011-10-17	Repair queued
Attachment A2_Matrix of Questions that Appear in the PRS and Protocols.docx	Supplementary Document	Uploaded 2011-10-17	Available
Attachment A1_Public Health Service Law Sec 301.doc	Supplementary Document	Uploaded 2011-10-17	Available
tribal HPOG_Supporting Statement Part B_Renewal_August 2014v4_clean.doc	Supporting Statement B	Uploaded 2014-08-20	Available
Attachment A10_Focus Group Recruitment Flyer.doc	Supplementary Document	Uploaded 2011-06-20	Repair queued
Attachment A9_Telephone Interview Recruitment Letter.doc	Supplementary Document	Uploaded 2011-06-20	Available
Attachment A8_Focus Group Recruitment Letter.doc	Supplementary Document	Uploaded 2011-06-20	Repair queued
Attachment A7_Administrative Staff, Implementation Staff, Employers Recruitment Letter.doc	Supplementary Document	Uploaded 2011-06-20	Available
Attachment A6_Grantee Advance Letter.doc	Supplementary Document	Uploaded 2011-06-20	Repair queued
Attachment A5_NORC IRB Approval.doc	Supplementary Document	Uploaded 2011-06-20	Repair queued
Attachment A4_Focus Group Informed Consent Form.doc	Supplementary Document	Uploaded 2011-06-20	Available
Attachment A3_Interview Informed Oral Consent.doc	Supplementary Document	Uploaded 2011-06-20	Available
Attachment A1_Public Health Service Law Sec 301.doc	Supplementary Document	Uploaded 2011-06-20	Available
Tribal HPOG_Supporting Statement Part A_Renewal_August 2014v4_clean.doc	Supporting Statement A	Uploaded 2014-08-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
198409	#6.Program Non-Completers Interview Protocol	Other-#6	Modified
198408	#5.Program Completers Interview Protocol	Other-#5	Modified
198407	#4.Program Participant Focus Group and Interview Protocol	Other-#4	Modified
198406	#3.Employer interview	Other-#3	Modified
198405	#2.Program implementation staff interview	Other-#2	Modified
198404	#1.Grantee and partner administrative staff interview	Other-#1	Modified

ICR Details

OMB Control No: 0970-0395	ICR Reference No: 201408-0970-004
Status: Historical Active	Previous ICR Reference No: 201107-0970-002
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Evaluation of Tribal Health Profession Opportunity Grants
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/25/2014
	Date Received in OIRA: 08/28/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2015	12 Months From Approved	10/31/2014
Responses	416	0	408
Time Burden (Hours)	493	0	485
Cost Burden (Dollars)	0	0	9,632

---

Abstract: The Administration for Children and Families (ACF) is requesting a one year extension from the Office of Management and Budget (OMB) to continue to collect qualitative data as part of the evaluation of the Tribal Health Professions Opportunity Grants (HPOG) to develop an understanding of the program's effectiveness in meeting the tribal health workforce needs. This extension will allow ACF to collect data on grantees through the completion of their grant period. Since initial approval of this information collection, no changes have been made to the instruments (interview and focus group protocols) or the time per response.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 5507 Name of Law: Patient Protection and Affordable Care 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:
	79 FR 33929	06/13/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 49522	08/21/2014
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
#6.Program Non-Completers Interview Protocol
#1.Grantee and partner administrative staff interview
#2.Program implementation staff interview
#3.Employer interview
#4.Program Participant Focus Group and Interview Protocol
#5.Program Completers Interview Protocol

---

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	416	408	0	8	0	0
Annual Time Burden (Hours)	493	485	0	8	0	0
Annual Cost Burden (Dollars)	0	9,632	0	-9,632	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: The estimated number of respondents for the Telephone Interviews with Program Completers was reduced based on experience to date with this project.

---

Annual Cost to Federal Government: $192,796

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

---

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: 08/28/2014

---