Title X Family Planning Outreach and Enrollment Data Collection

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0990-0423 Statement to OMB on Use of Automated Data Collection Techniques for Enrollment Assistance.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-12-12	Available
0990-Title X Family Planning_Section B Statistical Methods.doc	Supporting Statement B	Uploaded 2014-07-21	Available
0990-New_Title X Family PlanningOutreach and Enrollment Version ss. 2.docx	Supporting Statement A	Uploaded 2014-05-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
214237	Title X Outreach and Enrollment (O/E) Progress Report	Other-online survey	New
211642	Title X Outreach and Enrollment Report	Other-Report	Unchanged

ICR Details

OMB Control No: 0990-0423	ICR Reference No: 201412-0990-001
Status: Historical Active	Previous ICR Reference No: 201405-0990-004
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Title X Family Planning Outreach and Enrollment Data Collection
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/15/2014
	Date Received in OIRA: 12/12/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2017	08/31/2017	08/31/2017
Responses	8,400	0	4,200
Time Burden (Hours)	1,680	0	840
Cost Burden (Dollars)	0	0	0

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Abstract: OPA does not have any data on how many sites are assisting and enrolling clients into health insurance programs. Thus we seek to collect this data in order to understand the impact of Title X funded service sites on assisting and enrolling clients into insurance programs. We will utilize this information to guide strategic planning around how Title X service sites prepare for, and assist with, the full implementation of the ACA. Through a separate data collection process called the Family Planning Annual Report (FPAR) (OMB No. 0990-0221, expiration January 31, 2016), OPA collects information on the insurance status of the clients served.

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Authorizing Statute(s): PL: Pub.L. 91 - 572 1001 Name of Law: Population Reseach and Voluntary Family Planning Programs
  

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 66360	11/05/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 41689	07/17/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Title X Outreach and Enrollment Report
Title X Outreach and Enrollment (O/E) Progress Report

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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	8,400	4,200	0	4,200	0	0
Annual Time Burden (Hours)	1,680	840	0	840	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: No

Burden Reduction Due to:

Short Statement: This is not an increase or decrease in burden hour or respondents, just an adjustment to the electronic form.

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Annual Cost to Federal Government: $18,000

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]? Yes

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: 12/12/2014

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