Midwest HIV Prevention and Pregnancy Planning Initiative (MHPPPI)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0990_MHPPPI IRB_approval.pdf	Supplementary Document	Uploaded 2015-10-30	Available
0990-MHPPPI Section B Statistical 10-29-15.docx	Supporting Statement B	Uploaded 2015-10-30	Available
0990-MidwestHIVPreventionand_ss_10-29-15.docx	Supporting Statement A	Uploaded 2015-10-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
218820	Screening for patient interview	Other-survey	New
218819	Climate survey round 2	Other-survey	New
218818	Screening for climate survey round 2	Other-Provider	New
218816	Screening forclimate survey round 1	Other-survey	New
217100	Patient Qualitative Interview	Other-interview	New
216995	Climate Survey	Other-survey	New

ICR Details

OMB Control No: 0990-0439	ICR Reference No: 201503-0990-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Midwest HIV Prevention and Pregnancy Planning Initiative (MHPPPI)
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 with change	Conclusion Date: 11/06/2015
	Date Received in OIRA: 06/18/2015
Terms of Clearance: Limitations will be included in all publications, with attention to the limitations of a convenience sample, cross sectional data, online survey methodology, and qualitative methods. Study results will not be generalized to the broader population of providers encompassed within the entire MHPPPI network or the general Midwest provider population.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2018	36 Months From Approved
Responses	2,245	0	0
Time Burden (Hours)	198	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The evaluation framework for MHPPPI includes process monitoring, impact evaluation, outcome evaluation and dissemination. The impact evaluation will be informed by an initial climate survey of a sample of medical providers within the Midwest to develop a conservative baseline estimate of the counterfactual model. The counterfactual model will postulate what would have happened without the intervention. The impact evaluation will also document and analyze the degree to which services are integrated in medical settings based on change agent surveys administered through participating trainees. The outcome evaluation will assess changes that occurred in each domain as a result of the intervention, including knowledge, attitudes and behaviors related to the specific training content.

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Authorizing Statute(s): US Code: 42 USC 300u-2(a) 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:
	80 FR 12186	03/06/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 32572	06/09/2015
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
Screening forclimate survey round 1
Screening for climate survey round 2
Climate survey round 2
Climate Survey
Patient Qualitative Interview
Screening for patient 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	2,245	0	0	2,245	0	0
Annual Time Burden (Hours)	198	0	0	198	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: New collection

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Annual Cost to Federal Government: $37,350

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: 06/18/2015

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