Senior Corps Independent Living Surveys and Performance Measure Aggregation Tool

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3 Respite Survey	Form and Instruction	Modified	Available
Form 2 Independent Living Survey	Form and Instruction	Modified	Available
Form 1 Data Aggregation Tool	Form	Modified	Available
SCP PM Data Aggregation Tool Justification FINAL.doc	Supporting Statement A	Uploaded 2017-04-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
207237	Independent Living Performance Measures Aggregation Tool	Form and Instruction	Modified	Respite Survey
207237	Independent Living Performance Measures Aggregation Tool	Form and Instruction	Modified	Independent Living Survey
207237	Independent Living Performance Measures Aggregation Tool	Form	Modified	Data Aggregation Tool
207237	Independent Living Performance Measures Aggregation Tool	Instruction	Modified

ICR Details

OMB Control No: 3045-0152	ICR Reference No: 201701-3045-001
Status: Historical Active	Previous ICR Reference No: 201306-3045-001
Agency/Subagency: CNCS	Agency Tracking No:
Title: Senior Corps Independent Living Surveys and Performance Measure Aggregation Tool
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/11/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/12/2017
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	53,470	0	0
Time Burden (Hours)	26,735	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Senior Corps adopted new, required performance measures for its programs beginning in Fiscal Year 2013. Under a separate information collection approval, two Independent Living Performance Measures Surveys were cleared for use by grantees of the Senior Companion Program (required) and the RSVP Program (optional). This information collection requests adds the surveys to the aggregation tool as additional instruments. The Independent Living Performance Measures Aggregation Tool will serve as the required template for grantees to use to provide two levels of information: (1) A row on the spreadsheet template corresponding to each individual client, without any personal information that could identify the individual; and (2) aggregate project level performance measures data for submission to CNCS.

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Authorizing Statute(s): US Code: 42 USC 12501 et seq Name of Law: National Community Service Law of 1994 as amended
  

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:
	81 FR 31612	05/19/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 3759	01/12/2017
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Independent Living Performance Measures Aggregation Tool	2, 3, 1	Data Aggregation Tool ,   Independent Living Survey ,   Respite Survey

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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	53,470	0	0	53,120	0	350
Annual Time Burden (Hours)	26,735	0	0	24,285	0	2,450
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: The burden has increased because we have incorporated the instruments from a previously cleared information collection request into this clearance for the aggregation tool.

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Annual Cost to Federal Government: $0

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

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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: 01/12/2017

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