Performance Monitoring of “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Youth Serving Organization (YSO) Staff Survey	Form and Instruction	Unchanged	Available
Att 11a YSO Performance Measure Reporting Tool Online Version	Form	Modified	Available
Att 9a YSO Organizational Assessment Online Version	Form	Modified	Available
Health Center Provider Survey	Form and Instruction	Unchanged	Available
Att 8a Annual Health Center Performance Measure Reporting Tool Online Version	Form	Modified	Available
Att 8 Annual Health Center Perfornce Meure Repting Tool clean	Form and Instruction	Modified	Available
Quarterly Health Center Performance Measure Reporting Tool	Form and Instruction	Unchanged	Available
Health Center Organizational Assessment	Form and Instruction	Unchanged	Available
Helath Center Youth Survey	Form and Instruction	Unchanged	Available
Att 13a Awardee Performance Measure Reporting Tool Online Version	Form	Modified	Available
Att 13 Awardee Performance Measure Reporting Tool clean	Form and Instruction	Modified	Available
Awardee Training and Technical Assistance Tool	Form and Instruction	Unchanged	Available
Att 10a YSO Staff Survey Online Version	Form	Modified	Available
Att 10 YSO Staff Survey clean	Form and Instruction	Modified	Available
Youth Serving Organization Performance Measure Reporting Tool	Form and Instruction	Unchanged	Available
Att 6a Health Center Youth Survey Online Version	Form	Modified	Repair queued
Att 6a Health Center Youth Survey Online Version	Form and Instruction	Modified	Available
Att 5a Health Center Provider Survey Online Version	Form	Modified	Available
Att 5 Health Center Provider Survey clean	Form and Instruction	Modified	Available
Att 8a Annual Health Center Performance Measure Reporting Tool Online Version	Form	Modified	Available
Att 8 Annual Health Center Performance Measure Reporting Tool clean	Form and Instruction	Modified	Available
Att 7a Quarterly Health Center Performance Measure Reporting Tool Online Version	Form	Modified	Available
Att 7 Quarterly Health Center Performance Measure Reporting Tool clean	Form and Instruction	Modified	Available
Att 4a Health Center Organizational Assessment Online Version	Form	Modified	Available
Att 4 Health Center Organizational Assessment 03_01_2017 clean	Form and Instruction	Modified	Available
0920-1156 Change Request Justification.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-03-21	Available
SS Part B_6 29 2016.docx	Supporting Statement B	Uploaded 2016-07-12	Available
REV SS Part A_Working with Public Centers TPP_03_7_2017_clean.docx	Supporting Statement A	Uploaded 2017-03-21	Available
Att 14 logic model.docx	Supplementary Document	Uploaded 2016-07-12	Available
Att 3 Crosswalk of Objectives and Data Sources_4-7-2016.docx	Supplementary Document	Uploaded 2016-07-12	Available
684_Working iwth Publicly funded HCs to reduce TPP.pdf	Supplementary Document	Uploaded 2016-07-12	Available
Att 2b 0902-16MM Public Comment.txt	Supplementary Document	Uploaded 2016-07-07	Available
Att 2a 0920-16MM 60-day FRN.pdf	Supplementary Document	Uploaded 2016-07-07	Available
Att 1-Authorizing Legislation.pdf	Supplementary Document	Uploaded 2016-07-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
222392	Youth Serving Organization (YSO) Staff Survey	Form and Instruction	Unchanged	Youth Serving Organization (YSO) Staff Survey
222389	Youth Serving Organization (YSO) Performance Measure Reporting Tool	Form	Modified	Att 11a YSO Performance Measure Reporting Tool Online Version
222387	Youth Serving Organization (YSO) Organizational Assessment	Form	Modified	Att 9a YSO Organizational Assessment Online Version
222386	Health Center Provider Survey	Form and Instruction	Unchanged	Health Center Provider Survey
222376	Annual Health Center Performance Measure Reporting Tool	Form	Modified	Att 8a Annual Health Center Performance Measure Reporting Tool Online Version
222376	Annual Health Center Performance Measure Reporting Tool	Form and Instruction	Modified	Att 8 Annual Health Center Perfornce Meure Repting Tool clean
222375	Quarterly Health Center Perfoemance Measure Reporting Tool	Form and Instruction	Unchanged	Quarterly Health Center Performance Measure Reporting Tool
222374	Health Center Organizational Assessment	Form and Instruction	Unchanged	Health Center Organizational Assessment
222373	Health Center Youth Survey	Form and Instruction	Unchanged	Helath Center Youth Survey
222372	Awardee Performance Measure Reporting Tool	Form	Modified	Att 13a Awardee Performance Measure Reporting Tool Online Version
222372	Awardee Performance Measure Reporting Tool	Form and Instruction	Modified	Att 13 Awardee Performance Measure Reporting Tool clean
222371	Awardee Training and Techmnical Assistance Tool	Form and Instruction	Unchanged	Awardee Training and Technical Assistance Tool
222370	Youth Serving Organization (YSO) Staff Survey	Form	Modified	Att 10a YSO Staff Survey Online Version
222370	Youth Serving Organization (YSO) Staff Survey	Form and Instruction	Modified	Att 10 YSO Staff Survey clean
222369	Youth Serving Organization (YSO) Performance Measure Reporting Tool	Form and Instruction	Unchanged	Youth Serving Organization Performance Measure Reporting Tool
222368	Youth Serving Organization (YSO) Organizational Assessment	Form	Modified	Att 6a Health Center Youth Survey Online Version
222368	Youth Serving Organization (YSO) Organizational Assessment	Form and Instruction	Modified	Att 6a Health Center Youth Survey Online Version
222367	Health Center Provider Survey	Form	Modified	Att 5a Health Center Provider Survey Online Version
222367	Health Center Provider Survey	Form and Instruction	Modified	Att 5 Health Center Provider Survey clean
222366	Annual Health Center Performance Measure Reporting Tool	Form	Modified	Att 8a Annual Health Center Performance Measure Reporting Tool Online Version
222366	Annual Health Center Performance Measure Reporting Tool	Form and Instruction	Modified	Att 8 Annual Health Center Performance Measure Reporting Tool clean
222365	Quarterly Health Center Performance Measure Reporting Tool	Form	Modified	Att 7a Quarterly Health Center Performance Measure Reporting Tool Online Version
222365	Quarterly Health Center Performance Measure Reporting Tool	Form and Instruction	Modified	Att 7 Quarterly Health Center Performance Measure Reporting Tool clean
222364	Health Center Organizational Assessment	Form	Modified	Att 4a Health Center Organizational Assessment Online Version
222364	Health Center Organizational Assessment	Form and Instruction	Modified	Att 4 Health Center Organizational Assessment 03_01_2017 clean

ICR Details

OMB Control No: 0920-1156	ICR Reference No: 201703-0920-010
Status: Historical Active	Previous ICR Reference No: 201607-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-16MM
Title: Performance Monitoring of “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations
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: 03/23/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/22/2017
Terms of Clearance: Previous terms continue: Approved consistent with the understanding that this collection will measure outcomes intended to facilitate program improvement and development. Collection activities are not intended to produce generalizable outcomes regarding teen pregnancy or reproductive health.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2020	01/31/2020	01/31/2020
Responses	2,064	0	2,064
Time Burden (Hours)	1,150	0	1,150
Cost Burden (Dollars)	0	0	0

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Abstract: CDC obtained the current approval in January 2017. Since submitting the 30 day notice and accompanying materials in June 2016, CDC identified funds that allowed us to support development of an online data collection system intended to make responding simpler by utilizing automatic skip patterns while also simplifying data submission. In the process of developing the online data collection system, we noted places in the currently approved measures that would need slight modifications (e.g., small changes to directions, changing from a table to a question format) in order to function correctly in the online measures. We also noted places where the measures could be made clearer. As a result, CDC is now requesting approval of these minor changes to the previously approved versions of the measures that were created in word. There is no change in burden associated with these changes.

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Authorizing Statute(s): US Code: 42 USC 241 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:
	81 FR 6270	02/05/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 45166	07/12/2016
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 17

table that charts list of burden

IC Title	Form No.	Form Name
Annual Health Center Performance Measure Reporting Tool	N/A, N/A	Att 8 Annual Health Center Perfornce Meure Repting Tool clean ,   Att 8a Annual Health Center Performance Measure Reporting Tool Online Version
Annual Health Center Performance Measure Reporting Tool	N/A, N/A	Att 8 Annual Health Center Performance Measure Reporting Tool clean ,   Att 8a Annual Health Center Performance Measure Reporting Tool Online Version
Awardee Performance Measure Reporting Tool	N/A, N/A	Att 13 Awardee Performance Measure Reporting Tool clean ,   Att 13a Awardee Performance Measure Reporting Tool Online Version
Awardee Training and Techmnical Assistance Tool	NA	Awardee Training and Technical Assistance Tool
Health Center Organizational Assessment	NA	Health Center Organizational Assessment
Health Center Organizational Assessment	N/A, N/A	Att 4 Health Center Organizational Assessment 03_01_2017 clean ,   Att 4a Health Center Organizational Assessment Online Version
Health Center Provider Survey	NA	Health Center Provider Survey
Health Center Provider Survey	N/A, N/A	Att 5 Health Center Provider Survey clean ,   Att 5a Health Center Provider Survey Online Version
Health Center Youth Survey	NA	Helath Center Youth Survey
Quarterly Health Center Perfoemance Measure Reporting Tool	NA	Quarterly Health Center Performance Measure Reporting Tool
Quarterly Health Center Performance Measure Reporting Tool	N/A, N/A	Att 7 Quarterly Health Center Performance Measure Reporting Tool clean ,   Att 7a Quarterly Health Center Performance Measure Reporting Tool Online Version
Youth Serving Organization (YSO) Organizational Assessment	N/A	Att 9a YSO Organizational Assessment Online Version
Youth Serving Organization (YSO) Organizational Assessment	N/A, N/A	Att 6a Health Center Youth Survey Online Version ,   Att 6a Health Center Youth Survey Online Version
Youth Serving Organization (YSO) Performance Measure Reporting Tool	N/A	Att 11a YSO Performance Measure Reporting Tool Online Version
Youth Serving Organization (YSO) Performance Measure Reporting Tool	NA	Youth Serving Organization Performance Measure Reporting Tool
Youth Serving Organization (YSO) Staff Survey	NA	Youth Serving Organization (YSO) Staff Survey
Youth Serving Organization (YSO) Staff Survey	N/A, N/A	Att 10 YSO Staff Survey clean ,   Att 10a YSO Staff Survey Online Version

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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	2,064	2,064	0	0	0	0
Annual Time Burden (Hours)	1,150	1,150	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:

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Annual Cost to Federal Government: $232,215

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: 03/22/2017

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