Health Profession Opportunity Grants (HPOG) program: Third Follow-Up Data Collection

Forms and Documents

Document Name	Status
HPOG Followup OMB Appendix M_Contact Update Call Script_052417.docx Supplementary Document	2017-06-14
HPOG Followup OMB Appendix K2 72-month Survey Advance Letter_052017.docx Supplementary Document	2017-06-14
HPOG Followup OMB Appendix K1 Previously Approved 36-month Survey Advance Letter.docx Supplementary Document	2017-06-14
HPOG Followup OMB Appendix J_ 72_month_Email Reminder_052017.docx Supplementary Document	2017-06-14
HPOG Followup OMB Appendix I_ 72_month_Survey Flyer_052017.docx Supplementary Document	2017-06-14
HPOG Followup OMB Appendix H_Participant Newsletter_052017.docx Supplementary Document	2017-06-14
HPOG Followup OMB Appendix G Previously Approved Consent Forms for Participant Surveys.pdf Supplementary Document	2017-06-14
HPOG Followup OMB Appendix F2_72 Month_Contact Update Letter_052017.docx Supplementary Document	2017-06-14
HPOG Followup OMB Appendix F1_Previously Approved_Contact Update Letter.docx Supplementary Document	2017-06-14
HPOG Followup OMB Appendix E_Previously Approved_Contact Update Form.docx Supplementary Document	2017-06-14
HPOG Followup OMB Appendix C 72 Month Followup Survey Sources 042017.docx Supplementary Document	2017-06-14
HPOG Followup OMB Appendix A HPOG Logic Model.docx Supplementary Document	2017-06-14
HPOG 1 Impact 72 Mo Follow-up OMB Part B 06062017.docx Supporting Statement B	2017-06-14
HPOG 1 Impact 72 Mo Follow-up OMB Part A -06092017.docx Supporting Statement A	2017-06-14

IC Document Collections

IC ID	Document Title	Status
227177	HPOG-Impact 72-Month Follow-up Survey Other-Survey	New
212776	HPOG-NIE Performance Measurement Semi-Structured Discussion Guide Other-Discussion Guide	Removed
212775	HPOG-NIE Performance Measurement Screening Questionnaire Other-Screener	Removed
212774	HPOG-Impact 36-month Control Group Follow-Up survey Other-Survey	Modified
212773	HPOG-Impact 36-month Participant Follow-Up survey Other-Survey	Modified
206801	HPOG-NIE 15-month Participant Follow-Up survey Other-Survey	Removed
206800	HPOG-Impact 15-month Control Group Member Follow-Up survey Other-Survey	Removed
206799	HPOG-Impact 15-month Participant Follow-Up survey Other-Survey	Removed
198341	Semi-annual HPOG Program Performance Report Other-Word	Removed

ICR Details

OMB Control No: 0970-0394	ICR Reference No: 201706-0970-003
Status: Historical Active	Previous ICR Reference No: 201508-0970-005
Agency/Subagency: HHS/ACF	Agency Tracking No: 19416
Title: Health Profession Opportunity Grants (HPOG) program: Third Follow-Up Data Collection
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/18/2017
	Date Received in OIRA: 06/16/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2020	36 Months From Approved	12/31/2017
Responses	3,221	0	5,966
Time Burden (Hours)	2,974	0	6,292
Cost Burden (Dollars)	0	0	0

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Abstract: ACF is implementing a multi-pronged research and evaluation approach for the HPOG program to better understand and assess the activities conducted and their results. HPOG-Impact is one project within the broader portfolio of research that OPRE is utilizing to assess the success of career pathways programs and models. This strategy includes a multi-pronged research and evaluation approach for the HPOG program (including this impact study and the national implementation evaluation), as well as the Pathways for Advancing Careers and Education (PACE) study (0970-0397), to better understand and assess the activities conducted and their results. Four data collections related to this current submission were previously approved by the Office of Management and Budget (OMB) under OMB Clearance number 0970-0394. This submission seeks OMB approval for an additional follow-up data collection instrument: a 72-month follow-up survey for the HPOG-Impact study.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 Title V, Subtitle F, Sec. 5507 Name of Law: Patient Protection and Affordable Care 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:
	82 FR 3797	01/12/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 27710	06/16/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
HPOG-NIE Performance Measurement Screening Questionnaire
HPOG-NIE Performance Measurement Semi-Structured Discussion Guide
HPOG-Impact 36-month Participant Follow-Up survey
HPOG-Impact 36-month Control Group Follow-Up survey
HPOG-Impact 72-Month Follow-up Survey
Semi-annual HPOG Program Performance Report
HPOG-Impact 15-month Participant Follow-Up survey
HPOG-Impact 15-month Control Group Member Follow-Up survey
HPOG-NIE 15-month Participant Follow-Up survey

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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	3,221	5,966	0	-2,745	0	0
Annual Time Burden (Hours)	2,974	6,292	0	-3,318	0	0
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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This evaluation involves new and continuing data collection that increases the public reporting burden under this OMB number. Additionally, some data collection under this OMB number has been completed.

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Annual Cost to Federal Government: $2,186,876

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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

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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: 06/16/2017

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