Office of Adolescent Health Teen Pregnancy Prevention, FY 2015-2020 Performance Measure Collection

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0990-0438 OAH Non-substantive Change Memo Request to remove cost measures rev.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-04-25	Available
0990-Performance Measures_Part_A_Supporting_Statement_10 21 15 Clean.docx	Supporting Statement A	Uploaded 2015-10-22	Available
0990-Performance Measures_Part_B_Supporting_Statement.docx	Supporting Statement B	Uploaded 2015-06-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
218696	Cost	Other-survey	Unchanged
218695	Fidelity	Other-survey	Unchanged
218694	Dosage	Other-survey	Unchanged
218693	Participants reach	Other-survey	Unchanged
218692	Health-care linkages	Other-survey	Unchanged
218691	Number of Facilitators	Other-survey	Unchanged
215318	Number of partners	Other-SURVEY	Unchanged
215314	Grantee program staff	Other-SURVEY	Unchanged

ICR Details

OMB Control No: 0990-0438	ICR Reference No: 201704-0990-002
Status: Historical Active	Previous ICR Reference No: 201502-0990-006
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Office of Adolescent Health Teen Pregnancy Prevention, FY 2015-2020 Performance Measure Collection
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: 04/27/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/25/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2018	10/31/2018	10/31/2018
Responses	1,344	0	1,344
Time Burden (Hours)	1,252	0	1,252
Cost Burden (Dollars)	0	0	0

---

Abstract: The performance measures data collection will fulfill several important functions. First, OAH expects its grantees to utilize the measures to make continuous quality improvement in their program implementation and inform their partners and stakeholders about implementation and sustainability progress. Second, performance measures provide OAH with metrics for monitoring TPP grantees so that project officers can provide technical assistance when needed. Finally, OAH uses the measures to report to OASH, OS, our budget office, and Congress on the grantees' progress. Performance Measure data collection is a requirement of all TPP grant awards and is included in the funding announcements.

---

Authorizing Statute(s): PL: Pub.L. 103 - 62 4 Name of Law: 1993 Government Performance and Results Act
   PL: Pub.L. 113 - 76 4 Name of Law: Consolidation Appropriation Act, 2014
   PL: Pub.L. 113 - 164 4 Name of Law: Continuing Resolution for 2015
  

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 9723	02/24/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 34164	06/15/2015
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Cost
Dosage
Fidelity
Grantee program staff
Health-care linkages
Number of Facilitators
Number of partners
Participants reach

---

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	1,344	1,344	0	0	0	0
Annual Time Burden (Hours)	1,252	1,252	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: $309,920

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: 04/25/2017

---