OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

National Healthy Start Evaluation and Quality Assurance

ICR 201609-0915-003 · OMB 0915-0338 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form B3 Redesigned Preconception, Pregnancy and Parenting (3P's) Information Forms 3-6 Form and Instruction New Repair queued
Form B2 Redesigned Preconception, Pregnancy and Parenting (3P's) Information Form: Pregnancy Form and Instruction New Repair queued
Form F Community Action Network (CAN) Survey Form and Instruction Modified Available
Form B1 Redesigned Preconception, Pregnancy and Parenting (3P's) Information Form: Demographic Intake Form and Instruction Modified Repair queued
Form E National Healthy Start Program Survey (NHSPS) Form and Instruction Modified Repair queued
L. Healthy Start Evaluation SOW.docx Supplementary Document Uploaded 2016-09-16 Repair queued
C1. Healthy Start OMB Change Memo_3Ps.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-09-16 Repair queued
C3. Original 3 P's Information Form.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-09-16 Repair queued
C2. Reformatted 3Ps crosswalk_Final.xlsx Justification for No Material/Nonsubstantive Change Uploaded 2016-09-16 Available
K. Healthy Start Evaluation IRB Package.pdf Supplementary Document Uploaded 2016-09-16 Repair queued
J2. NHSPS and CAN Pilot Test Results.docx Supplementary Document Uploaded 2016-09-16 Available
J1. Redesigned 3Ps Pilot Test Report.docx Supplementary Document Uploaded 2016-09-16 Available
D. Healthy Start Benchmarks.pdf Supplementary Document Uploaded 2016-09-16 Available
A. Healthy Start Reauthorization Act of 2007.pdf Supplementary Document Uploaded 2016-09-16 Available
Supporting Statement B_0915-0338_Revision_11-2-16.docx Supporting Statement B Uploaded 2016-11-04 Repair queued
FINALSupporting Statement A_0915-0338_Revision_11-2-16.docx Supporting Statement A Uploaded 2016-11-04 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
223581 Redesigned Preconception, Pregnancy and Parenting (3P's) Information Forms 3-6 Form and Instruction New
223580 Redesigned Preconception, Pregnancy and Parenting (3P's) Information Form: Pregnancy Form and Instruction New
211291 Healthy Start Focus Group Protocol Instruction Modified
211290 Healthy Start Site Visit Protocol Instruction Modified
211289 Community Action Network (CAN) Survey Form and Instruction Modified
211288 Redesigned Preconception, Pregnancy and Parenting (3P's) Information Form: Demographic Intake Form and Instruction Modified
195559 National Healthy Start Program Survey (NHSPS) Form and Instruction Modified
ICR Details
0915-0338 201609-0915-003
Historical Active 201404-0915-007
HHS/HSA
National Healthy Start Evaluation and Quality Assurance
Revision of a currently approved collection   No
Regular
Approved with change 11/04/2016
Retrieve Notice of Action (NOA) 09/20/2016
  Inventory as of this Action Requested Previously Approved
11/30/2019 36 Months From Approved 06/30/2017
102,207 0 41,183
31,145 0 20,953
0 0 0
The national Healthy Start (HS) evaluation will include an implementation evaluation, which will describe program components that affect outcomes; a health services utilization evaluation, which will examine the characteristics of women and infants who did and did not utilize the program; and an outcome evaluation, which will assess the program’s effectiveness with regard to producing expected outcomes among the target population. The information collected will be used to obtain consistent information across all 100 grantees about HS and its outcomes and in-depth information for 15 HS communities. Respondents include pregnant women and women of reproductive age that were served by HS and HS staff.
US Code: 42 USC 254c-8 Name of Law: Public Health Service Act
   PL: Pub.L. 110 - 339 122 Name of Law: Healthy Start Reauthorization Act of 2007
  
None
Not associated with rulemaking
  81 FR 41314 06/24/2016
81 FR 62911 09/13/2016
No
  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 102,207 41,183 0 61,024 0 0
Annual Time Burden (Hours) 31,145 20,953 0 10,192 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Using Information Technology
The same individuals (40,675) complete the Demographic Intake and Pregnancy Status/History forms, and a subset of these same individuals (20,337) also complete the Preconception, Prenatal, Postpartum, and Interconception/Parenting forms for total of 61,532 respondents and responses. A revision in the 3Ps form added to the burden amount as the instrument was separated into 6 forms from the 1 form in 2013. Information technology has assisted in decreasing the burden for some instruments.
$186,719
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Elyana Bowman 301 443-3983 [email protected]
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
09/20/2016