Educating and Training of Healthcare Violence Against Women

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0990-0442 Memorandum SFunn on item modification 2.5.2016.pdf	Justification for No Material/Nonsubstantive Change	Uploaded 2016-02-17	Available
0990-0422_Part B.docx	Supporting Statement B	Uploaded 2015-02-25	Available
0990-ET_IPV_SupportingStatement_7_01_14 v3.doc	Supporting Statement A	Uploaded 2015-02-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
220101	Three month follow-up	Other-survey	New
220099	Post-Assessment	Other-survey	New
220098	Pre-Assessment	Other-survey	New
212286	3-Month Follow-up Assessment	Other-survey	Removed
212285	Post-Assessment	Other-survey	Removed
212226	Pre-Assessment	Other-survey	Removed

ICR Details

OMB Control No: 0990-0422	ICR Reference No: 201602-0990-001
Status: Historical Active	Previous ICR Reference No: 201502-0990-011
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Educating and Training of Healthcare Violence Against Women
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: 02/23/2016
	Date Received in OIRA: 02/17/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	05/31/2018	05/31/2018
Responses	4,800	0	4,800
Time Burden (Hours)	2,001	0	2,001
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this data collection is to gather data from healthcare providers who have volunteered to participate in the pilot and evaluation of an e-learning course designed to educate and train healthcare providers on how to respond to intimate partner violence (IPV) against women. Information obtained from this data collection will be used to identify areas of improvement and measure the effectiveness of the e-learning course in educating healthcare providers about IPV, addressing attitudinal barriers to IPV screening, and increasing IPV screening in clinical practice.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 2713 Name of Law: The 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 68883	11/19/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 9723	02/24/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Pre-Assessment
Pre-Assessment
Post-Assessment
Post-Assessment
Three month follow-up
3-Month Follow-up Assessment

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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	4,800	4,800	0	4,800	-4,800	0
Annual Time Burden (Hours)	2,001	2,001	0	2,001	-2,001	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: non substantial request

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Annual Cost to Federal Government: $410,817

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: 02/17/2016

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