National Survey of Older Americans Act Participants

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 National Survey of OAA Participants	Form and Instruction	Modified	Available
12th_NSOAAP_OMB_PRA_Appendices_14june2017.docx	Supplementary Document	Uploaded 2017-06-26	Available
12th_NSOAAP_Survey_Instrument_26may2017_AppendixG.docx	Supplementary Document	Uploaded 2017-06-26	Available
FINAL_Appendix_9th_National_Survey_Older_Americans_Participants_OMB_PRA_July_11_2014.docx	Supplementary Document	Uploaded 2014-07-15	Repair queued
Supporting Statement B for the 12th National Survey of OAA Participants .docx	Supporting Statement B	Uploaded 2017-06-26	Available
12th_National Survey of Older Americans Act Participants (NSOAAP)_Supporting Statement 06.16.17_rev1feb2018.docx	Supporting Statement A	Uploaded 2018-02-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
182321	National Survey of OAA Participants	Form and Instruction	Modified

ICR Details

OMB Control No: 0985-0023	ICR Reference No: 201706-0985-002
Status: Historical Active	Previous ICR Reference No: 201404-0985-002
Agency/Subagency: HHS/ACL	Agency Tracking No:
Title: National Survey of Older Americans Act Participants
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/05/2018
	Date Received in OIRA: 06/26/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	36 Months From Approved	02/28/2018
Responses	6,250	0	6,250
Time Burden (Hours)	5,000	0	5,000
Cost Burden (Dollars)	0	0	0

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Abstract: The Administration for Community Living (ACL) has developed a core set of performance measures for state and community programs on aging operating under the Older Americans Act (OAA). The National Survey of Older Americans Act Participants (NSOAAP) assists ACL to meet the accountability provisions of the GPRA Modernization Act of 2010 (GPRAMA). ACL's NSOAAP utilizes survey modules based on its Performance Outcome Measures Projects.

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Authorizing Statute(s): PL: Pub.L. 109 - 365 206 Name of Law: Older Americans Act
   PL: Pub.L. 109 - 365 202(f) Name of Law: Older Americans Act
   PL: Pub.L. 109 - 365 205(a)(1)(C) Name of Law: Older Americans 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 13457	03/13/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 28491	06/22/2017
Did the Agency receive public comments on this ICR? Yes

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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
National Survey of OAA Participants	1	12th National Survey of OAA Participants Instrument

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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	6,250	6,250	0	0	0	0
Annual Time Burden (Hours)	5,000	5,000	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: $975,832

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.     Yes

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: 06/26/2017

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