Comprehensive HIV Prevention and Care for Men Who Have Sex with Men of Color

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
SSA_Thrive_3.20.17_Clean 4 13.docx	Supporting Statement A	Uploaded 2017-04-13	Available
Attachment 9 Project Determination.pdf	Supplementary Document	Uploaded 2016-11-28	Available
Attachment 8- Data Security Guidelines.pdf	Supplementary Document	Uploaded 2016-11-28	Available
Attachment 3. List of Thrive Grantees.docx	Supplementary Document	Uploaded 2016-11-28	Available
Attachment 2- 60Day FRN 11 21 2016.pdf	Supplementary Document	Uploaded 2016-11-28	Available
Attachment 1 Auth Legislation.docx	Supplementary Document	Uploaded 2016-11-28	Available
SSB_Clean.docx	Supporting Statement B	Uploaded 2017-04-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
224640	Funding Allocation Report (THRIVE Awardees only)	Instruction	New
224637	Collaborative Assessment Tool (THRIVE Awardees)	Instruction	New
224635	Qualitative Interview: Collaborative Process Evaluation (THRIVE Awardees)	Instruction	New
224634	M&E Data Elements on HIV Prevention and Care Services (THRIVE Awardees)	Instruction	New
224631	Collaborative Assessment Tool (THRIVE Partners)	Instruction	New
224630	Qualitative Interview: Collaborative Process Evaluation (THRIVE Partners)	Instruction	New
224629	M&E Data Elements on HIV Prevention and Care Services (THRIVE Partners)	Instruction	New

ICR Details

OMB Control No: 0920-1178	ICR Reference No: 201611-0920-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-16ET
Title: Comprehensive HIV Prevention and Care for Men Who Have Sex with Men of Color
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: 04/17/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/30/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2020	36 Months From Approved
Responses	355	0	0
Time Burden (Hours)	1,543	0	0
Cost Burden (Dollars)	39,895	0	0

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Abstract: Gay, bisexual, and other men who have sex with men (MSM) remain the population most affected by HIV infection in the United States. Among MSM, those who are black and Hispanic comprise 64% of all new infections. The purpose of this data collection is to support state and local health departments and their community partners to provide comprehensive models of HIV prevention and care services for MSM of color.

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Authorizing Statute(s): US Code: 42 USC 242(k) 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:
	80 FR 74106	11/27/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 85962	11/29/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
Collaborative Assessment Tool (THRIVE Awardees)
Collaborative Assessment Tool (THRIVE Partners)
Funding Allocation Report (THRIVE Awardees only)
M&E Data Elements on HIV Prevention and Care Services (THRIVE Awardees)
M&E Data Elements on HIV Prevention and Care Services (THRIVE Partners)
Qualitative Interview: Collaborative Process Evaluation (THRIVE Awardees)
Qualitative Interview: Collaborative Process Evaluation (THRIVE Partners)

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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	355	0	0	355	0	0
Annual Time Burden (Hours)	1,543	0	0	1,543	0	0
Annual Cost Burden (Dollars)	39,895	0	0	39,895	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 a new information collection request.

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Annual Cost to Federal Government: $472,825

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: 11/30/2016

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