National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care: Evaluation of Awareness, Adoption, and Implementation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0990-NCSAppendix A - Overarching Evaluation Questions.docx	Supplementary Document	Uploaded 2015-06-08	Available
0990-Appendix J - SRA NCS Evaluation Timeline (as of 1.26.15).docx	Supplementary Document	Uploaded 2015-06-08	Available
0990-Appendix B - NCS Evaluation EQ Crosswalk.docx	Supplementary Document	Uploaded 2015-06-08	Repair queued
0990-National CLAS Standards Evaluation Informed Consent - Leadership Interview_June 1 2015.docx	Supplementary Document	Uploaded 2015-06-08	Available
0990-National CLAS Standards Evaluation Informed Consent for Staff Survey_June 1 2015.docx	Supplementary Document	Uploaded 2015-06-03	Available
0990-National CLAS Standards Evaluation Informed Consent - Leadership Interview_June 1 2015.docx	Supplementary Document	Uploaded 2015-06-03	Available
0990-Section B National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care_June 1.docx	Supporting Statement B	Uploaded 2015-06-03	Available
NCS Supporting Statement_June 8 2015_1200pm.docx	Supporting Statement A	Uploaded 2015-06-08	Available
Assessment and Evaluation Plan Timeline_9-23-14.docx	Supplementary Document	Uploaded 2014-12-22	Available
Informed Consent Form_9-23-14.docx	Supplementary Document	Uploaded 2014-12-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
214393	National CLAS Standards Experience Form	Other-form	New
214391	Health and Healthcare Organization Screener Survey	Other-screener	New
214390	Health and Health Care Organization Staff Survey	Other-survey	New
214389	Health and Healthcare Organization Leadership Interview	Other-interview	New
214388	CLAS Stakeholder Interview	Other-interview	New
214386	National CLAS Standards Stakeholder Interview	Other-interview	New

ICR Details

OMB Control No: 0990-0429	ICR Reference No: 201412-0990-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care: Evaluation of Awareness, Adoption, and Implementation
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/12/2015
	Date Received in OIRA: 01/06/2015
Terms of Clearance: Due to the limits of the methodology, this qualitative assessment should not be used as the basis for statements about the outcomes of this program, or as the basis for funding decisions.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2018	36 Months From Approved
Responses	292,683	0	0
Time Burden (Hours)	44,970	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this assessment is to systematically describe and examine the awareness, knowledge, adoption, and implementation of the HHS OMH's National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (hereafter referred to as the National CLAS Standards) in a sample of health and health care organizations, and to use the resultant data to develop a preliminary, model of implementation to guide organizational adoption and implementation of the National CLAS Standards.

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Authorizing Statute(s): US Code: 42 USC 301 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 57930	09/26/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 75811	12/19/2014
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
National CLAS Standards Stakeholder Interview
Health and Healthcare Organization Screener Survey
Health and Healthcare Organization Leadership Interview
Health and Health Care Organization Staff Survey
National CLAS Standards Experience Form
CLAS Stakeholder Interview

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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	292,683	0	0	292,683	0	0
Annual Time Burden (Hours)	44,970	0	0	44,970	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 a new collection

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Annual Cost to Federal Government: $139,622

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: 01/06/2015

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