Pregnancy Assistance Fund Feasibility And Design Study(Positive Adolescent Futures)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
30-dayFederal Register, Volume 81 Issue 164 (Wednesday, August 24, 2016).htm	Supplementary Document	Uploaded 2016-08-25	Repair queued
60-day Federal Register, Volume 81 Issue 89 (Monday, May 9, 2016).htm	Supplementary Document	Uploaded 2016-08-25	Repair queued
SS_B.docx	Supporting Statement B	Uploaded 2016-08-16	Available
0990-0424 PAF 24 Mo FU Supporting Statement A OMB_revised 11212016.docx	Supporting Statement A	Uploaded 2016-11-22	Available
Attachment E_Confidentiality Pledge PAF FU.pdf	Supplementary Document	Uploaded 2016-08-16	Available
0990-0424Attachment G_PAF Follow up Pretest Memorandum.docx	Supplementary Document	Uploaded 2016-01-06	Repair queued
0990-0424 Attachment E_Confidentiality Pledge PAF FU.pdf	Supplementary Document	Uploaded 2016-01-06	Available
0990-0424Attachment C_Sources Referenced for PAF Follow Up.docx	Supplementary Document	Uploaded 2016-01-06	Available
0990-0424Attachment D_Persons Consulted.docx	Supplementary Document	Uploaded 2016-01-06	Available
0990-0424Attachment F_PAF Analysis Plan for Impact Study_FU.docx	Supplementary Document	Uploaded 2016-01-06	Available
0990-Attachment J_PAF_Consent Letters and Forms and Youth Assent Form_08262014.docx	Supplementary Document	Uploaded 2014-08-29	Available
0990-SupplementalDoc_Attachment B_Email Template for Interview.docx	Supplementary Document	Uploaded 2014-06-25	Available
0990-SupplementDoc_Attachment A_Overview of PAF Evaluation.docx	Supplementary Document	Uploaded 2014-06-25	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
223049	24 month Followup survey California and Texas	Other-survey	New
212904	12 Month follow-up survey of impact study participants	Other-survey	Unchanged
212078	Baseline Survey of impact study participants	Other-baseline survey	Modified
212077	Grantee Interview Protocol	Other-guide	Modified

ICR Details

OMB Control No: 0990-0424	ICR Reference No: 201604-0990-002
Status: Historical Active	Previous ICR Reference No: 201601-0990-001
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Pregnancy Assistance Fund Feasibility And Design Study(Positive Adolescent Futures)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/02/2016
	Date Received in OIRA: 08/25/2016
Terms of Clearance: Previous terms continue: Results of the three separate program evaluations contained within this collection are not intended to be generalized to the broader Pregnancy Assistance Fund grantee national network. Upon publication and communication of this collection's outcomes, the Agency will clearly describe the research limitations and specific scope of this collection.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2019	36 Months From Approved	01/31/2019
Responses	1,757	0	1,251
Time Burden (Hours)	938	0	683
Cost Burden (Dollars)	0	0	0

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Abstract: The objective of the Pregnancy Assistance Fund (PAF) Feasibility and Design Study (FADS) is to establish a foundation for a rigorous impact and implementation evaluation. Specifically, FADS will: (1) assess design options for implementation and impact evaluation, (2) document how PAF programs are operationalized in the field, (3) identify and enter into agreements with two or three sites for the evaluation, (4) provide assistance to sites to support a rigorous evaluation framework, (5) develop all evaluation instruments and obtain clearance, and (6) pilot baseline data collection. As described below, the evaluation will have two main components: the Design and Implementation Analysis and the Impact Study.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 10211-10214 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:
	81 FR 28085	05/09/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 57922	08/24/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Baseline Survey of impact study participants
12 Month follow-up survey of impact study participants
Grantee Interview Protocol
24 month Followup survey California and Texas

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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	1,757	1,251	0	506	0	0
Annual Time Burden (Hours)	938	683	0	255	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: OMB gave approval on August 30, 2014, for the PAF baseline survey and telephone interviews across 17 Pregnancy Assistance Fund grantees (OMB Control # 0990-0424) and under the same OMB control number gave approval for the 12-month follow up survey on January 7, 2016. We now seek a revision to the existing approval to add the data collection associated with the 24-month follow-up survey instruments. This request is an adjustment increasing the total burden from 682.67 hours to 935.17 hours.

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Annual Cost to Federal Government: $451,452

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: 08/25/2016

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