Capacity Building Assistance Program: Assessment and Quality Control

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Att 3_Health Professional Application for Training (HPAT)	Form	Modified	Repair queued
Non Substantive Request Justification_10 25 2016.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2016-10-25	Available
Att 15 InterviewEmail.docx	Supplementary Document	Uploaded 2015-12-02	Available
Att 12 TA_Reminder_Email.docx	Supplementary Document	Uploaded 2015-12-02	Repair queued
Att 11 Training_Reminder_Email.docx	Supplementary Document	Uploaded 2015-12-02	Repair queued
Att 10 TA_Intro_Email.docx	Supplementary Document	Uploaded 2015-12-02	Available
Att 9 Training_Intro_Email.docx	Supplementary Document	Uploaded 2015-12-02	Available
Att 17 Security Controls.docx	Supplementary Document	Uploaded 2015-08-21	Available
Att 2a Public Comment.docx	Supplementary Document	Uploaded 2015-07-28	Repair queued
Att 2 60-Day FRN.pdf	Supplementary Document	Uploaded 2015-07-28	Repair queued
Att 1 Auth Legislation.docx	Supplementary Document	Uploaded 2015-07-28	Available
SupSta B_081315.docx	Supporting Statement B	Uploaded 2015-08-20	Available
SupSta A -020516.rev.docx	Supporting Statement A	Uploaded 2016-02-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
217967	Att 16_CBA Key Informant Interview Script	Other-WORD	Unchanged
217966	Att 14_Technical Assistance Telephone Script for Nonresponders	Other-WORD	Unchanged
217965	Att 13 Training Telephone Script for Nonresponders	Other-WORD	Unchanged
217676	Att 7_Technical Assistance (TA) Satisfaction Instrument	Other-WORD	Unchanged
217675	Att 5_Training Follow-Up Instrument (TFI)	Other-WORD	Unchanged
217674	Att 3_Health Professional Application for Training (HPAT)	Form	Modified

ICR Details

OMB Control No: 0920-1099	ICR Reference No: 201610-0920-011
Status: Historical Active	Previous ICR Reference No: 201507-0920-014
Agency/Subagency: HHS/CDC	Agency Tracking No: 17BH
Title: Capacity Building Assistance Program: Assessment and Quality Control
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: 10/31/2016
	Date Received in OIRA: 10/26/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2019	02/28/2019	02/28/2019
Responses	44,440	0	44,440
Time Burden (Hours)	8,643	0	8,643
Cost Burden (Dollars)	0	0	0

---

Abstract: The Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention (DHAP) Capacity Building Branch provides capacity building assistance (CBA), such as training and technical assistance, to community-based organizations, health departments, and healthcare organizations that provide HIV prevention services (e.g., HIV testing, risk reduction counseling, linkage to medical care, HIV awareness information). CBA services ensure that on-the-ground HIV prevention programs and their staff have the skills, information, and organizational support they need to reduce the spread of HIV. CBA services are most often provided to staff in positions such as HIV educator, clinical supervisor, HIV prevention specialist, clinician, outreach worker, case manager director, program coordinator, program manager, disease intervention specialist, partner services provider, physicians, nurses, and health educators, etc. These staff will be asked questions about the CBA services that they received, such as how satisfied they were with the CBA services and how they benefitted from them. This study will assess the degree to which the recipients of CBA services were satisfied with CBA services (e.g., training and technical assistance) and the degree to which they benefitted from CBA services, including changes in knowledge and skills.

---

Authorizing Statute(s): US Code: 42 USC 792 Name of Law: Research and Investigations
  

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:
	80 FR 9724	02/24/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 160	08/19/2015
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Att 13 Training Telephone Script for Nonresponders
Att 16_CBA Key Informant Interview Script
Att 14_Technical Assistance Telephone Script for Nonresponders
Att 3_Health Professional Application for Training (HPAT)	N/A, N/A	Health Professional Application for Training ,   Health Professional Application for Training
Att 5_Training Follow-Up Instrument (TFI)
Att 7_Technical Assistance (TA) Satisfaction Instrument

---

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	44,440	44,440	0	0	0	0
Annual Time Burden (Hours)	8,643	8,643	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $726,734

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

---

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: 10/26/2016

---