Performance Monitoring of “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Youth Serving Organization (YSO) Staff Survey	Form and Instruction	New	Available
Youth Serving Organization (YSO) Performance Measure Reporting Tool	Form and Instruction	New	Repair queued
Youth Serving Organization (YSO) Organizational Assessment	Form and Instruction	New	Available
Health Center Provider Survey	Form and Instruction	New	Available
Annual Health Center Performance Measure Reporting Tool	Form and Instruction	New	Available
Quarterly Health Center Performance Measure Reporting Tool	Form and Instruction	New	Repair queued
Health Center Organizational Assessment	Form and Instruction	New	Available
Helath Center Youth Survey	Form and Instruction	New	Available
Awardee Performance Measure Reporting Tool	Form and Instruction	New	Available
Awardee Training and Technical Assistance Tool	Form and Instruction	New	Available
Youth Serving Organization Staff Survey	Form and Instruction	New	Available
Youth Serving Organization Performance Measure Reporting Tool	Form and Instruction	New	Available
Youth Serving Organization (YSO) Organizational Assessment	Form and Instruction	New	Repair queued
Health Center Provider Survey	Form and Instruction	New	Available
Annual Health Center Performance Measure Reporting Tool	Form and Instruction	New	Available
Quarterly Health Center Performance Measure Reporting Tool	Form and Instruction	New	Available
Health Center Organizational Assessment	Form and Instruction	New	Available
SS Part B_6 29 2016.docx	Supporting Statement B	Uploaded 2016-07-12	Available
SS Part A_6 29 2016.docx	Supporting Statement A	Uploaded 2016-07-12	Available
Att 14 logic model.docx	Supplementary Document	Uploaded 2016-07-12	Available
Att 3 Crosswalk of Objectives and Data Sources_4-7-2016.docx	Supplementary Document	Uploaded 2016-07-12	Available
684_Working iwth Publicly funded HCs to reduce TPP.pdf	Supplementary Document	Uploaded 2016-07-12	Available
Att 2b 0902-16MM Public Comment.txt	Supplementary Document	Uploaded 2016-07-07	Available
Att 2a 0920-16MM 60-day FRN.pdf	Supplementary Document	Uploaded 2016-07-07	Available
Att 1-Authorizing Legislation.pdf	Supplementary Document	Uploaded 2016-07-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
222392	Youth Serving Organization (YSO) Staff Survey	Form and Instruction	New	Youth Serving Organization (YSO) Staff Survey
222389	Youth Serving Organization (YSO) Performance Measure Reporting Tool	Form and Instruction	New	Youth Serving Organization (YSO) Performance Measure Reporting Tool
222387	Youth Serving Organization (YSO) Organizational Assessment	Form and Instruction	New	Youth Serving Organization (YSO) Organizational Assessment
222386	Health Center Provider Survey	Form and Instruction	New	Health Center Provider Survey
222376	Annual Health Center Performance Measure Reporting Tool	Form and Instruction	New	Annual Health Center Performance Measure Reporting Tool
222375	Quarterly Health Center Perfoemance Measure Reporting Tool	Form and Instruction	New	Quarterly Health Center Performance Measure Reporting Tool
222374	Health Center Organizational Assessment	Form and Instruction	New	Health Center Organizational Assessment
222373	Health Center Youth Survey	Form and Instruction	New	Helath Center Youth Survey
222372	Awardee Performance Measure Reporting Tool	Form and Instruction	New	Awardee Performance Measure Reporting Tool
222371	Awardee Training and Techmnical Assistance Tool	Form and Instruction	New	Awardee Training and Technical Assistance Tool
222370	Youth Serving Organization (YSO) Staff Survey	Form and Instruction	New	Youth Serving Organization Staff Survey
222369	Youth Serving Organization (YSO) Performance Measure Reporting Tool	Form and Instruction	New	Youth Serving Organization Performance Measure Reporting Tool
222368	Youth Serving Organization (YSO) Organizational Assessment	Form and Instruction	New	Youth Serving Organization (YSO) Organizational Assessment
222367	Health Center Provider Survey	Form and Instruction	New	Health Center Provider Survey
222366	Annual Health Center Performance Measure Reporting Tool	Form and Instruction	New	Annual Health Center Performance Measure Reporting Tool
222365	Quarterly Health Center Performance Measure Reporting Tool	Form and Instruction	New	Quarterly Health Center Performance Measure Reporting Tool
222364	Health Center Organizational Assessment	Form and Instruction	New	Health Center Organizational Assessment

ICR Details

OMB Control No: 0920-1156	ICR Reference No: 201607-0920-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-16MM
Title: Performance Monitoring of “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations
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 without change	Conclusion Date: 01/19/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/13/2016
Terms of Clearance: Approved consistent with the understanding that this collection will measure outcomes intended to facilitate program improvement and development. Collection activities are not intended to produce generalizable outcomes regarding teen pregnancy or reproductive health.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2020	36 Months From Approved
Responses	2,064	0	0
Time Burden (Hours)	1,150	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: To evaluate and improve efforts of three organizations under the cooperative agreement “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Vulnerable Populations” to 1) work with health centers to enhance implementation of best practices in adolescent reproductive health care and 2) work with youth-serving organizations (YSOs) to develop systematic approaches to referring youth at risk for a teen pregnancy to reproductive health care. Information collected will be used to monitor awardee performance and determine training and technical assistance needs to address any performance issues.

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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:
	81 FR 6270	02/05/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 45166	07/12/2016
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 17

table that charts list of burden

IC Title	Form No.	Form Name
Annual Health Center Performance Measure Reporting Tool	NA	Annual Health Center Performance Measure Reporting Tool
Annual Health Center Performance Measure Reporting Tool	NA	Annual Health Center Performance Measure Reporting Tool
Awardee Performance Measure Reporting Tool	NA	Awardee Performance Measure Reporting Tool
Awardee Training and Techmnical Assistance Tool	NA	Awardee Training and Technical Assistance Tool
Health Center Organizational Assessment	NA	Health Center Organizational Assessment
Health Center Organizational Assessment	NA	Health Center Organizational Assessment
Health Center Provider Survey	NA	Health Center Provider Survey
Health Center Provider Survey	NA	Health Center Provider Survey
Health Center Youth Survey	NA	Helath Center Youth Survey
Quarterly Health Center Perfoemance Measure Reporting Tool	NA	Quarterly Health Center Performance Measure Reporting Tool
Quarterly Health Center Performance Measure Reporting Tool	NA	Quarterly Health Center Performance Measure Reporting Tool
Youth Serving Organization (YSO) Organizational Assessment	NA	Youth Serving Organization (YSO) Organizational Assessment
Youth Serving Organization (YSO) Organizational Assessment	NA	Youth Serving Organization (YSO) Organizational Assessment
Youth Serving Organization (YSO) Performance Measure Reporting Tool	NA	Youth Serving Organization (YSO) Performance Measure Reporting Tool
Youth Serving Organization (YSO) Performance Measure Reporting Tool	NA	Youth Serving Organization Performance Measure Reporting Tool
Youth Serving Organization (YSO) Staff Survey	NA	Youth Serving Organization (YSO) Staff Survey
Youth Serving Organization (YSO) Staff Survey	NA	Youth Serving Organization Staff Survey

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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	2,064	0	0	2,064	0	0
Annual Time Burden (Hours)	1,150	0	0	1,150	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: Submission of 0920-16MM is a New ICR.

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Annual Cost to Federal Government: $232,215

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: 07/13/2016

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