Evaluation of Older Americans Act Title VI Programs

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 8 Program Staff Focus Group Consent Form	Form	New	Available
Form 8 Title VI Other Program Staff Focus Group	Form and Instruction	New	Available
Form 7 Tribal Caregiver Survey Consent Form	Form	New	Available
Form 7 Title VI Tribal Caregiver Survey	Form and Instruction	New	Available
Form 6 Tribal Caregiver Group Consent Form	Form	New	Available
Form 6 Title VI Caregiver Focus Group	Form and Instruction	New	Available
Form 5 Tribal Elders Interview Consent Form	Form	New	Available
Form 5 Title VI Tribal Elders Interview	Form and Instruction	New	Available
Form 4 Tribal Elder Focus Group Consent Form	Form	New	Available
Form 4 Title VI Elders Focus Group	Form and Instruction	New	Available
Form 3 Program Staff Interview Consent Form	Form	New	Available
Form 3 Title VI Other Program Staff Interview Guide	Form and Instruction	New	Available
Form 2 Program Staff Focus Group Consent Form	Form	New	Available
Form 2 Title VI Program Staff Focus Moderator Guide	Form and Instruction	New	Available
Form 1 Program Staff Interview Consent Form	Form	New	Available
Form 1 Title VI Program Staff Interview Guide	Form and Instruction	New	Available
Title VI Evaluation Supporting Statement Part B.docx	Supporting Statement B	Uploaded 2017-12-21	Available
D. Title VI Eval Questions and Data Sources.pdf	Supplementary Document	Uploaded 2017-07-17	Available
C. Title VI Medicine Wheel.pdf	Supplementary Document	Uploaded 2017-07-17	Available
B. Title VI Logic Model.pdf	Supplementary Document	Uploaded 2017-07-17	Available
Title VI Supporting Statement Part A Indian Nutrition 12.12.17.docx	Supporting Statement A	Uploaded 2017-12-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
229429	Evaluation Older Americans Act Title VI Programs Other Program Staff Focus	Form	New	Program Staff Focus Group Consent Form
229429	Evaluation Older Americans Act Title VI Programs Other Program Staff Focus	Form and Instruction	New	Title VI Other Program Staff Focus Group
227564	Evaluation of Older Americans Act Title VI Programs-Tribal Caregivers Survey	Form	New	Tribal Caregiver Survey Consent Form
227564	Evaluation of Older Americans Act Title VI Programs-Tribal Caregivers Survey	Form and Instruction	New	Title VI Tribal Caregiver Survey
227562	Evaluation of Older Americans Act Title VI Programs - Caregiver Focus Group	Form	New	Tribal Caregiver Group Consent Form
227562	Evaluation of Older Americans Act Title VI Programs - Caregiver Focus Group	Form and Instruction	New	Title VI Caregiver Focus Group
227560	Evaluation of Older Americans Act Title VI Programs-Tribal Interview	Form	New	Tribal Elders Interview Consent Form
227560	Evaluation of Older Americans Act Title VI Programs-Tribal Interview	Form and Instruction	New	Title VI Tribal Elders Interview
227558	Evaluation of Older Americans Act Title VI - Tribal Elders Focus Group	Form	New	Tribal Elder Focus Group Consent Form
227558	Evaluation of Older Americans Act Title VI - Tribal Elders Focus Group	Form and Instruction	New	Title VI Elders Focus Group
227539	Evaluation of the Older Americans Title VI Programs - Other Program Staff - Interview	Form	New	Program Staff Interview Consent Form
227539	Evaluation of the Older Americans Title VI Programs - Other Program Staff - Interview	Form and Instruction	New	Title VI Other Program Staff Interview Guide
227538	Evaluation of Older Americans Act Title VI Program Staff-Focus Group	Form	New	Program Staff Focus Group Consent Form
227538	Evaluation of Older Americans Act Title VI Program Staff-Focus Group	Form and Instruction	New	Title VI Program Staff Focus Moderator Guide
227537	Evaluation of Older Americans Act Programs Title VI - Program Staff-Interviews	Form	New	Program Staff Interview Consent Form
227537	Evaluation of Older Americans Act Programs Title VI - Program Staff-Interviews	Form and Instruction	New	Title VI Program Staff Interview Guide

ICR Details

OMB Control No: 0985-0059	ICR Reference No: 201707-0985-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACL	Agency Tracking No:
Title: Evaluation of Older Americans Act Title VI Programs
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/05/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/27/2017
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
Responses	345	0	0
Time Burden (Hours)	495	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Older Americans Act (OAA) outlines care for AI/AN/NH Elders through the Title VI Programs, which include nutrition, disease prevention and health promotion, and caregiver support services. Title VI Part A, the Indian Program, serves federally recognized tribes with at least 50 members ages 60 years and above; Part B, the Native Hawaiian Program, serves public or nonprofit private organizations that serve Native Hawaiians and represent at least 50 individuals ages 60 years and above; Part C, the Native American Caregiver Support Program, serves all programs with Parts A and B. In 2014, the Administration for Community Living (ACL) conducted an evaluability assessment of the Title VI Programs in order to gain understanding of the characteristics, context, and intended outcomes of the nutrition, supportive, and caregiver support services and best approaches for a full-scale evaluation of the Title VI Programs. Through the assessment, a 20-member stakeholder advisory group, consisting of representatives from the National Indian Council on Aging, the National Resources Center on Native American Aging, as well as Title VI program grantees, provided input and guidance on the best way to evaluate the Title VI Program in a culturally responsive way. The goal of the evaluation is to learn more about how Tribes organize and manage their Title VI programs; and how the programs better the lives of the older American Indian, Alaska Native, and Native Hawaiian populations and to answer the following key questions: • How are the Title VI Programs implemented at the national and tribal levels? • What is the effect of Title VI Programs, nationally and by tribe or tribal groups? • Do Title VI Programs that rely on Title VI funds alone have a different impact than programs that have money from other programs or agencies?

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Authorizing Statute(s): PL: Pub.L. 109 - 365 206 Name of Law: Older Americans Act
   US Code: 42 USC 3017 Name of Law: Evaluation of Programs
  

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 11471	02/23/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 28066	06/20/2017
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Evaluation Older Americans Act Title VI Programs Other Program Staff Focus	8, 8	Title VI Other Program Staff Focus Group ,   Program Staff Focus Group Consent Form
Evaluation of Older Americans Act Programs Title VI - Program Staff-Interviews	1, 1	Title VI Program Staff Interview Guide ,   Program Staff Interview Consent Form
Evaluation of Older Americans Act Title VI - Tribal Elders Focus Group	4, 4	Title VI Elders Focus Group ,   Tribal Elder Focus Group Consent Form
Evaluation of Older Americans Act Title VI Program Staff-Focus Group	2, 2	Title VI Program Staff Focus Moderator Guide ,   Program Staff Focus Group Consent Form
Evaluation of Older Americans Act Title VI Programs - Caregiver Focus Group	6, 6	Title VI Caregiver Focus Group ,   Tribal Caregiver Group Consent Form
Evaluation of Older Americans Act Title VI Programs-Tribal Caregivers Survey	7, 7	Title VI Tribal Caregiver Survey ,   Tribal Caregiver Survey Consent Form
Evaluation of Older Americans Act Title VI Programs-Tribal Interview	5, 5	Title VI Tribal Elders Interview ,   Tribal Elders Interview Consent Form
Evaluation of the Older Americans Title VI Programs - Other Program Staff - Interview	3, 3	Title VI Other Program Staff Interview Guide ,   Program Staff Interview Consent Form

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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	345	0	0	345	0	0
Annual Time Burden (Hours)	495	0	0	495	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: No

Burden Reduction Due to:

Short Statement: This is a new information collection.

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Annual Cost to Federal Government: $223,639

Does this IC contain surveys, censuses, or employ statistical methods? No

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]? 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: 07/27/2017

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