Health Profession Opportunity Grants (HPOG) program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
HPOG Memo to OMB to Text Message - 8.10.15.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-08-11	Repair queued
HPOG NIE and Impact SSB_Revised August 2015_clean.docx	Supporting Statement B	Uploaded 2015-08-11	Available
Memo to OMB_Online Form_final 6.11.15.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-06-12	Available
HPOG Appendix H Contact Letter and Form_6.11.15 - revised 8.11.15.docx	Supplementary Document	Uploaded 2015-08-11	Available
Appendix I Survey Advance Letter clean.docx	Supplementary Document	Uploaded 2014-12-03	Available
Appendix D HPOG Impact 36-mo Followup Table of Contents REVISED clean.docx	Supplementary Document	Uploaded 2014-12-03	Available
Appendix A HPOG Logic Model - Revised - clean.docx	Supplementary Document	Uploaded 2014-12-03	Available
Previously Submitted Appendix_Information on the Full ISIS Sample Frame.docx	Supplementary Document	Uploaded 2014-08-22	Available
Previously Approved Tracking Letter and Contact Update form.docx	Supplementary Document	Uploaded 2014-08-22	Available
Previously Approved Supplementary Documents.pdf	Supplementary Document	Uploaded 2014-08-22	Available
Previously Approved HPOG-Impact and HPOG-NIE Advance letter.docx	Supplementary Document	Uploaded 2014-08-22	Available
Previously Approved Consent Forms for Participant Surveys 5-2.pdf	Supplementary Document	Uploaded 2014-08-22	Available
HPOG-ISIS Questions by Research Obj 7 26 13.xlsx	Supplementary Document	Uploaded 2013-08-07	Available
HPOG NIE and Impact Supporting Statement_Part A REVISED 111814 clean.docx	Supporting Statement A	Uploaded 2014-12-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
212776	HPOG-NIE Performance Measurement Semi-Structured Discussion Guide	Other-Discussion Guide	Unchanged
212775	HPOG-NIE Performance Measurement Screening Questionnaire	Other-Screener	Unchanged
212774	HPOG-Impact 36-month Control Group Member Follow-Up survey	Other-Survey	Modified
212773	HPOG-Impact 36-month Participant Follow-Up survey	Other-Survey	Modified
206801	HPOG-NIE 15-month Participant Follow-Up survey	Other-Survey	Modified
206800	HPOG-Impact 15-month Control Group Member Follow-Up survey	Other-Survey	Modified
206799	HPOG-Impact 15-month Participant Follow-Up survey	Other-Survey	Modified
198341	Semi-annual HPOG Program Performance Report	Other-Word	Unchanged

ICR Details

OMB Control No: 0970-0394	ICR Reference No: 201508-0970-005
Status: Historical Active	Previous ICR Reference No: 201506-0970-008
Agency/Subagency: HHS/ACF	Agency Tracking No: 19416
Title: Health Profession Opportunity Grants (HPOG) program
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: 08/20/2015
	Date Received in OIRA: 08/14/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	12/31/2017	12/31/2017
Responses	5,966	0	5,966
Time Burden (Hours)	6,292	0	6,292
Cost Burden (Dollars)	0	0	0

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Abstract: ACF is implementing a multi-pronged research and evaluation approach for the HPOG program to better understand and assess the activities conducted and their results. The current submission is in support of the HPOG Impact Study (HPOG-Impact) and the HPOG National Implementation Evaluation (HPOG-NIE). Specifically, ACF seeks approval for 36-month follow up data collection for HPOG-Impact and for follow-on HPOG-NIE data collection activities. All 27 HPOG grantees serving TANF recipients and other low-income individuals are participating in HPOG-NIE; 20 are participating in HPOG-Impact. HPOG-Impact and HPOG-NIE are two projects within the broader portfolio of research that OPRE is utilizing to assess the success of the career pathways programs and models. This strategy includes a multi-pronged research and evaluation approach for the HPOG program to better understand and assess the activities conducted and their results as well as the Innovative Strategies for Improving Self-Sufficiency (ISIS) project. In order to maximize learning across the portfolio, survey development for the HPOG and ISIS baseline and follow up surveys is being coordinated, and the majority of the data elements collected in these surveys are similar.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 5507 Name of Law: Patient Protection and Affordable Care 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 35547	06/23/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 51174	08/27/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Semi-annual HPOG Program Performance Report
HPOG-Impact 15-month Participant Follow-Up survey
HPOG-Impact 15-month Control Group Member Follow-Up survey
HPOG-NIE 15-month Participant Follow-Up survey
HPOG-NIE Performance Measurement Semi-Structured Discussion Guide
HPOG-Impact 36-month Participant Follow-Up survey
HPOG-Impact 36-month Control Group Member Follow-Up survey
HPOG-NIE Performance Measurement Screening Questionnaire

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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	5,966	5,966	0	0	0	0
Annual Time Burden (Hours)	6,292	6,292	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $4,630,736

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]? 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: 08/14/2015

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