National Hospital Organ Donation Campaign's Activity Scorecard

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Hospital Campaign Activity Scorecard	Form and Instruction	Modified	Available
0373 Hospital Campaign Change Memo CLEAN.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2018-09-26	Available
2017 HospitalCampaign LeadershipTeam CLEAN Round 2.docx	Supplementary Document	Uploaded 2017-01-19	Available
HospitalCampaign List of Partners CLEAN Round 2.docx	Supplementary Document	Uploaded 2017-01-19	Available
SupportingStatement_Scorecard CLEAN Round 2.docx	Supporting Statement A	Uploaded 2017-01-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
209057	Hospital Campaign Activity Scorecard	Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0373	ICR Reference No: 201809-0915-002
Status: Historical Active	Previous ICR Reference No: 201701-0915-006
Agency/Subagency: HHS/HSA	Agency Tracking No: 20741
Title: National Hospital Organ Donation Campaign's Activity Scorecard
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: 10/05/2018
	Date Received in OIRA: 09/27/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2020	03/31/2020	03/31/2020
Responses	1,250	0	1,250
Time Burden (Hours)	459	0	459
Cost Burden (Dollars)	0	0	0

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Abstract: The Hospital Campaign Activity Scorecard was developed to: 1) motivate and assist hospitals to conduct donor registration activities by providing a turn-key menu of outreach strategies to simplify and facilitate activity implementation, 2) provide a basis for reward and recognition, and 3) evaluate the Hospital Campaign efforts.

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Authorizing Statute(s): PL: Pub.L. 108 - 216 377A(a) Name of Law: ORGAN DONATION AND RECOVERY IMPROVEMENT ACT
   US Code: 42 USC 3777A(a) 274f-1 Name of Law: PHS 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 79506	11/14/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 4899	01/17/2017
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
Hospital Campaign Activity Scorecard	1, 2	FINALCleanChallengeScorecard ,   OMB Hospital Campaign Challenge Scorecard CLEAN.docx

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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	1,250	1,250	0	0	0	0
Annual Time Burden (Hours)	459	459	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: $20,530

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: 09/27/2018

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