National HIV Prevention Program Monitoring and Evaluation (NHM&E)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Community-Based Organization Report - NHME	Form and Instruction	New	Available
Health Department Report - NHME	Form and Instruction	New	Available
Att 10 SummaryOfChanges.docx	Supplementary Document	Uploaded 2016-02-09	Available
Supporting Statement B DD 080515.docx	Supporting Statement B	Uploaded 2015-09-02	Available
Supporting Statement A 05FEB2016.docx	Supporting Statement A	Uploaded 2016-02-09	Available
Project Determination.pdf	Supplementary Document	Uploaded 2015-08-26	Available
Att 9 Assurance of Confidentiality.pdf	Supplementary Document	Uploaded 2015-08-26	Available
Att 8 Burden Calculations.docx	Supplementary Document	Uploaded 2015-08-26	Available
Att 7 EvalWeb Authority to Operate.pdf	Supplementary Document	Uploaded 2015-08-26	Available
Att 6 Data Security Guidelines.pdf	Supplementary Document	Uploaded 2015-08-26	Available
Att 4 Agencies and Persons Consulted.doc	Supplementary Document	Uploaded 2015-08-26	Available
Att 3 EvalWeb home page login screen.docx	Supplementary Document	Uploaded 2015-08-26	Available
Att 2 60 Day FRN.pdf	Supplementary Document	Uploaded 2015-08-26	Available
Att 1 Legislative Authority.pdf	Supplementary Document	Uploaded 2015-08-26	Available
IRB Determination.pdf	Supplementary Document	Uploaded 2013-01-03	Available
Final Renewal AoC NHM&E Document (3).pdf	Supplementary Document	Uploaded 2013-01-03	Available
Attach7 CDC HIV Data Collections.docx	Supplementary Document	Uploaded 2013-01-03	Available
Attach8 Eval-Web_ATO.pdf	Supplementary Document	Uploaded 2013-01-03	Available
Attach4 Agencies and Persons Consulted.doc	Supplementary Document	Uploaded 2013-01-03	Available
Attach2 60 Day FRN Published.pdf	Supplementary Document	Uploaded 2013-01-03	Available
Attach1 Legislative Authority.pdf	Supplementary Document	Uploaded 2013-01-03	Available
Attachment 6 B CDC Data Systems ROB Systems Administrators.pdf	Supplementary Document	Uploaded 2013-01-28	Available
Attach6 A CDC Data Systems ROB System Users.pdf	Supplementary Document	Uploaded 2013-01-28	Available
Attach5 PEB NHME Comprehensive DVS v11-02-2012.pdf	Supplementary Document	Uploaded 2013-01-03	Available
Attachment 3 A PEMS Home Page.docx	Supplementary Document	Uploaded 2010-06-21	Available
Attach5 PEB NHME Comprehensive DVS v11-02-2012.pdf	Supplementary Document	Uploaded 2013-01-03	Available
Attach5 PEB NHME Comprehensive DVS v11-02-2012.pdf	Supplementary Document	Uploaded 2013-01-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7165	Health Department Data	Other-Evaluation Web	Removed
217851	Community-Based Organization Report - NHME	Form and Instruction	New
217850	Health Department Report - NHME	Form and Instruction	New
205581	Community Based Organizations: NH&E Data Training	Other-WORD	Removed
180694	Community Based Organization HE/RR Data	Other-EvaluationWeb	Removed
180693	Community-Based Organizations - Agency Data	Other-EvaluationWeb	Removed

ICR Details

OMB Control No: 0920-0696	ICR Reference No: 201508-0920-003
Status: Historical Active	Previous ICR Reference No: 201301-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 0696
Title: National HIV Prevention Program Monitoring and Evaluation (NHM&E)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/09/2016
	Date Received in OIRA: 09/03/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2019	36 Months From Approved	03/31/2016
Responses	538	0	1,338
Time Burden (Hours)	206,226	0	206,226
Cost Burden (Dollars)	0	0	0

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Abstract: CDC is requesting approval for a 3 year revision of a previously approved project. The revision of the currently approved data collection is intended to adjust the data collection to meet the monitoring and evaluation needs of new CDC HIV prevention goals developed in response to the White House National HIV/AIDS Strategy (NHAS) and "High Impact Prevention". There are also adjustments to streamline data collection and account for changes in HIV prevention technology and policy. CDC will continue collecting standardized HIV prevention program data from health departments and community-based organizations (CBOs) who receive Federal funds for HIV prevention activities. Grantees have the option of key-entering or uploading data to a CDC provided web-based software application. The reporting is necessary to ensure that CDC receives standardized, accurate evaluation data.

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Authorizing Statute(s): US Code: 42 USC 241 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 22197	04/21/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 50291	08/19/2015
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
Health Department Data
Community-Based Organizations - Agency Data
Community Based Organization HE/RR Data
Community Based Organizations: NH&E Data Training
Health Department Report - NHME	NA	NHME Variables and Values Data Variable Set
Community-Based Organization Report - NHME	NA	NHME Variables and Values Data Variable Set

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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	538	1,338	0	-800	0	0
Annual Time Burden (Hours)	206,226	206,226	0	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Submission of 0920-0696 is a Revision that resulted in no net change in Burden Hours

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Annual Cost to Federal Government: $804,211

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: 09/03/2015

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