Information Collection Request

National and Tribal Evaluation of the 2nd Generation of the Health Profession Opportunity Grants

ICR 201809-0970-007 · OMB 0970-0462 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
DRAFT HPOG 2.0 Memo to OMB_Post-Training Changes to Instrument 12_09272018.docx Justification for No Material/Nonsubstantive Change Uploaded 2018-09-28 Available
DRAFT HPOG 2.0 Memo to OMB_Pretest Changes _Expanded Site Visits_V4_091118_CLEAN.docx Justification for No Material/Nonsubstantive Change Uploaded 2018-09-11 Available
DRAFT HPOG 2.0 Memo to OMB_Pretest Changes _Expanded Site Visits_V4_091118_CLEAN.docx Justification for No Material/Nonsubstantive Change Uploaded 2018-09-11 Repair queued
Attachment O_ResearchQuestions for Previously Approved National and Tribal Evaluation Efforts.docx Supplementary Document Uploaded 2018-02-01 Available
Attachment N_HPOG2.0_Short-Term Followup Short-Term Survey_ Email Remind_revised_010918_clean.docx Supplementary Document Uploaded 2018-02-01 Repair queued
Attachment M_HPOG 2.0_Short-Term Survey Flyer 01092018.docx Supplementary Document Uploaded 2018-02-01 Available
Attachment L_HPOG 2.0 Short-Term Followup Followup Survey Sources_Rev_121217_Clean.docx Supplementary Document Uploaded 2018-02-01 Available
Attachment K_HPOG2.0_Short-Term Followup Survey Advance Letter_Rev_01092018_Clean.docx Supplementary Document Uploaded 2018-02-01 Available
Memo to OMB RE_Contact Update Form_05302017_Revised_07-11-17_CLEAN.DOCX Justification for No Material/Nonsubstantive Change Uploaded 2017-07-12 Available
Attachment K_HPOG 2 0 Incentive Communications_Email and Letter_071117 CLEAN.docx Supplementary Document Uploaded 2017-07-12 Available
Attachment J_Interview Verbal Informed Consent Form.docx Supplementary Document Uploaded 2016-10-24 Available
Attachment I_Focus Group Informed Consent Form.doc Supplementary Document Uploaded 2016-10-24 Available
Attachment H_HPOG- Model.pptx Supplementary Document Uploaded 2016-10-24 Available
Attachment B3_Tribal Evaluation Informed Consent Form B (Unique Identifiers).docx Supplementary Document Uploaded 2016-06-16 Available
Attachment B2_Tribal Evaluation Informed Consent Form A (SSNs).docx Supplementary Document Uploaded 2016-06-16 Available
Attachment B_Approved non-tribal, adult lottery not required consent form.docx Supplementary Document Uploaded 2016-06-16 Available
HPOG2 Supporting Statement_Updated Part A_June 2016 - TRACK CHANGES.docx Supplementary Document Uploaded 2016-06-16 Available
Memo to OMB RE_Revised Consent Forms for Tribal Study_06 15 16.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-06-16 Available
Memo to OMB RE_Revised Consent Forms 011116_v3.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-01-26 Available
Attachment A_References_Revised 09 02 16.docx Supplementary Document Uploaded 2016-10-24 Available
Attachment G. Contact Update Letter and Form.docx Supplementary Document Uploaded 2015-05-11 Repair queued
HPOG 2.0_Supporting Statement_Part B_091118_CLEAN.docx Supporting Statement B Uploaded 2018-09-11 Available
HPOG 2.0_Supporting Statement Part A_REV_091218_clean.docx Supporting Statement A Uploaded 2018-09-13 Available
Attachment F. First Round of HPOG Grantees Ressearch Portfolio_4.28.15.docx Supplementary Document Uploaded 2015-05-06 Available
FINAL updated Attachment E PPR Data List and Mockup 8 4 15 clean.docx Supplementary Document Uploaded 2015-08-05 Repair queued
Attachment D. Sources and Justification_5.4.15.docx Supplementary Document Uploaded 2015-05-06 Available
Attachment C_HPOG 2.0 15 mos follow up - 60 Day FRN_8.30.17.pdf Supplementary Document Uploaded 2018-02-01 Available
Attachment B. Informed Consent Forms_01.25.16 clean.docx Supplementary Document Uploaded 2016-01-26 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
229940 Instrument 12: Short-Term Follow-up Survey for the HPOG 2.0 National Evaluation Impact Evaluation Other-Survey Modified
229938 *NOT NEW* Instrument 5b: HPOG 2.0 National Evaluation letter and participant contact update form Other-Update Form Unchanged
224119 Instrument 11: HPOG 2.0 Tribal Evaluation program participant non-completer interviews Other-Interview Unchanged
224118 Instrument 10: HPOG 2.0 Tribal Evaluation program participant completer interviews Other-Interview Unchanged
224113 Instrument 9: HPOG 2.0 Tribal Evaluation program participant focus groups Other-Focus Group Unchanged
224112 Instrument 8: HPOG 2.0 Tribal Evaluation employer interviews Other-Interview Unchanged
224110 Instrument 7: HPOG 2.0 Tribal Evaluation program implementation staff interviews Other-Interview Unchanged
224107 Instrument 6: HPOG 2.0 Tribal Evaluation grantee and partner administrative staff interviews Other-Interview Unchanged
224101 Instrument 5a: HPOG 2.0 National Evaluation welcome packet, letter and participant contact update forms Other-Welcome Packet Unchanged
224098 Instrument 4: HPOG 2.0 National Evaluation in-person implementation interviews Other-Interview Unchanged
216432 PAGES Participant-Level Baseline Data Collection (participants at Tribal grantees) Other-Data collection System Unchanged
216431 PAGES Participant-Level Baseline Data Collection (participants at non-Tribal grantees participating in impact study) Other-Data collection System Unchanged
216430 PAGES Grantee- and Participant-Level Data Collection (all grantees) Other-Data collection System Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
06/30/2021 06/30/2021 06/30/2021
31,300 0 31,300
11,044 0 11,044
0 0 0





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 31,300 31,300 0 0 0 0
Annual Time Burden (Hours) 11,044 11,044 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No