Building Futures: Supporting Youth Living with HIV

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 2 Onsite_Observational_Tool	Form and Instruction	New	Available
Form 1 Online_Questionnaire_for_Pre-Work_Profile_of_RWHAP	Form and Instruction	New	Available
Supporting_Statement_A_HIV_Youth PASSBACK.v2_clean.docx	Supporting Statement A	Uploaded 2017-01-17	Available
Supporting_Statement_B_HIV_Youth PASSBACK.v2_clean.docx	Supporting Statement B	Uploaded 2017-01-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
223014	Building Futures: Supporting Youth Living with HIV	Form and Instruction	New	Onsite_Observational_Tool
223014	Building Futures: Supporting Youth Living with HIV	Form and Instruction	New	Online_Questionnaire_for_Pre-Work_Profile_of_RWHAP
223014	Building Futures: Supporting Youth Living with HIV	Other-Interview	New

ICR Details

OMB Control No: 0906-0023	ICR Reference No: 201608-0906-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Building Futures: Supporting Youth Living with HIV
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 with change	Conclusion Date: 01/30/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/25/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2020	36 Months From Approved
Responses	496	0	0
Time Burden (Hours)	523	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The Health Resources and Services Administration/HIV/AIDS Bureau (HRSA/HAB) is requesting approval from the Office of Management and Budget (OMB) for a study that will strengthen Ryan White HIV/AIDS Program (RWHAP) engagement with young people aged 13-24 living with HIV to improve their health outcomes. Through this project, HRSA/HAB will systematically document strategies used by providers funded by the RWHAP who have strong outcomes in areas of youth retention in care and viral suppression. HRSA/HAB will also learn about gaps and challenges from providers that have demonstrated poorer outcomes in these areas. Findings will inform technical assistance products to improve provider performance in engaging HIV-positive youth in care and optimizing health outcomes. Twenty-six RWHAP providers will participate in data collection through site visits.

---

Authorizing Statute(s): PL: Pub.L. 111 - 87 0 Name of Law: Ryan White HIV/AIDS Treatment Extension Act of 2009
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 24822	04/27/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 56663	08/22/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Building Futures: Supporting Youth Living with HIV	1 , 2	Online_Questionnaire_for_Pre-Work_Profile_of_RWHAP ,   Onsite_Observational_Tool

---

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	496	0	0	496	0	0
Annual Time Burden (Hours)	523	0	0	523	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: This is an increase from zero (0) as this is a new ICR.

---

Annual Cost to Federal Government: $388,539

Does this IC contain surveys, censuses, or employ statistical methods? No

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

---

Common Form ICR:  No

---

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

---