Pregnancy Assistance Fund (PAF) Implementation Study

Forms and Documents

Document Name	Status
PAF NonSub Change Request Memo_0990-0428.docx Justification for No Material/Nonsubstantive Change	2017-01-10
PAF Supporting Statement B_InDepth Study_Revised120216_track changes.docx Supporting Statement B	2017-01-10
PAF Supporting Statement A_InDepth Study_Revised120216_track changes.docx Supporting Statement A	2017-01-10

IC Document Collections

IC ID	Document Title	Status
215268	Guide for Youth Focus Group Other-discussion	Unchanged
215077	Program attendance and content coverage protocol Other-Data	Unchanged
215076	Staff survey Other-survey	Unchanged
215075	Staff Focus Group Other-Guide	Unchanged
215073	Semi- structured interview Other-Master guide	Unchanged

ICR Details

OMB Control No: 0990-0428	ICR Reference No: 201701-0990-003
Status: Historical Active	Previous ICR Reference No: 201502-0990-005
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Pregnancy Assistance Fund (PAF) Implementation Study
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: 01/11/2017
	Date Received in OIRA: 01/11/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	05/31/2018	05/31/2018
Responses	155	0	155
Time Burden (Hours)	163	0	163
Cost Burden (Dollars)	0	0	0

---

Abstract: The data will serve two main purposes. First, the information will enable the study team to produce clear, detailed descriptions of each intervention that is evaluated and the counterfactual in each site. This documentation is critical for understanding the meaning of impact estimates. Second, the data will be used to assess fidelity of implementation and the quality of program delivery. This information is essential for determining whether the interventions were implemented well and whether the evaluation provided a good test of each site's intervention.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 10211-10214 Name of Law: Patient Protection and Affordable Care Act (ACA)
  

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:
	79 FR 69119	11/20/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 8311	02/17/2015
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Semi- structured interview
Staff Focus Group
Staff survey
Program attendance and content coverage protocol
Guide for Youth Focus Group

---

ICR Summary 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	155	155	0	0	0	0
Annual Time Burden (Hours)	163	163	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: New collection

---

Annual Cost to Federal Government: $76,666

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]? Yes

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: 01/11/2017

---