ANA Consultant and Evaluator Qualifications Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 ANA Consultant and Evaluator Qualifications Form	Form and Instruction	Modified	Available
SUPPORTING STATEMENT-ANA REVIEWER PROFILE.doc	Supporting Statement A	Uploaded 2014-11-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
10119	ANA Consultant and Evaluator Qualifications Form	Form and Instruction	Modified

ICR Details

OMB Control No: 0970-0265	ICR Reference No: 201411-0970-006
Status: Historical Inactive	Previous ICR Reference No: 201012-0970-005
Agency/Subagency: HHS/ACF	Agency Tracking No: ANA
Title: ANA Consultant and Evaluator Qualifications Form
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted	Conclusion Date: 01/30/2015
	Date Received in OIRA: 11/20/2014
Terms of Clearance: This ICR was improperly submitted as a reinstatement without change, despite the fact that ACF has made revisions. ACF is requested to reclassify this package as a reinstatement with change upon resubmission.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The earlier version of this tool, "ANA Consultant and Evaluator Qualification Form" previously aproved under OMB #: 0970-0265 expired on 4/30/2014. ANA temporarily discontinued the tool to allow it more time to streamtine the document. ANA has completed the revision of some section of the document to eliminate duplication of reporting and to improve the clarity and content of the questions. These changes were designed to significantly reduce the burden on the respondents.

---

Authorizing Statute(s): US Code: 42 USC 2991 Name of Law: Panel Review of Applications for Assistance
  

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 3597	01/22/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 67171	11/12/2014
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
ANA Consultant and Evaluator Qualifications Form	1	ANA Panel Reviewer Profile Form

---

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 earlier version of this tool, "ANA Consultant and Evaluator Qualification Form" previously aproved under OMB #: 0970-0265 expired on 4/30/2014. ANA temporarily discontinued the tool to allow it more time to streamtine the document. ANA has completed the revision of some section of the document to eliminate duplication of reporting and to improve the clarity and content of the questions. These changes were designed to significantly reduce the burden on the respondents.

---

Annual Cost to Federal Government: $194

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: 11/20/2014

---