Annual Performance Reporting of the Administration for Community Living’s American Indian, Alaskan Natives and Native Hawaiian Programs

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Title VI PPR Part C	Form and Instruction	New	Available
Title VI PPR	Form and Instruction	New	Available
Form 8 Program Staff Focus Group Consent Form	Form	Removed	Available
Form 8 Title VI Other Program Staff Focus Group	Form and Instruction	Removed	Available
Form 7 Tribal Caregiver Survey Consent Form	Form	Removed	Available
Form 7 Title VI Tribal Caregiver Survey	Form and Instruction	Removed	Available
Form 6 Tribal Caregiver Group Consent Form	Form	Removed	Available
Form 6 Title VI Caregiver Focus Group	Form and Instruction	Removed	Available
Form 5 Tribal Elders Interview Consent Form	Form	Removed	Available
Form 5 Title VI Tribal Elders Interview	Form and Instruction	Removed	Available
Form 4 Tribal Elder Focus Group Consent Form	Form	Removed	Available
Form 4 Title VI Elders Focus Group	Form and Instruction	Removed	Available
Form 3 Program Staff Interview Consent Form	Form	Removed	Available
Form 3 Title VI Other Program Staff Interview Guide	Form and Instruction	Removed	Available
Form 2 Program Staff Focus Group Consent Form	Form	Removed	Available
Form 2 Title VI Program Staff Focus Moderator Guide	Form and Instruction	Removed	Available
Form 1 Program Staff Interview Consent Form	Form	Removed	Available
Form 1 Title VI Program Staff Interview Guide	Form and Instruction	Removed	Available
0985-0059 PPR Summary of Changes.xlsx	Supplementary Document	Uploaded 2019-04-03	Available
0059 Supporting Statement for Title VI PPR - 3.4.19.docx	Supporting Statement A	Uploaded 2019-03-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
234846	TITLE VI PROGRAM PERFORMANCE REPORT Part C	Form and Instruction	New	Title VI PPR Part C
234844	TITLE VI PROGRAM PERFORMANCE REPORT Part A/B	Form and Instruction	New	Title VI PPR
229429	Evaluation Older Americans Act Title VI Programs Other Program Staff Focus	Form	Removed	Program Staff Focus Group Consent Form
229429	Evaluation Older Americans Act Title VI Programs Other Program Staff Focus	Form and Instruction	Removed	Title VI Other Program Staff Focus Group
227564	Evaluation of Older Americans Act Title VI Programs-Tribal Caregivers Survey	Form	Removed	Tribal Caregiver Survey Consent Form
227564	Evaluation of Older Americans Act Title VI Programs-Tribal Caregivers Survey	Form and Instruction	Removed	Title VI Tribal Caregiver Survey
227562	Evaluation of Older Americans Act Title VI Programs - Caregiver Focus Group	Form	Removed	Tribal Caregiver Group Consent Form
227562	Evaluation of Older Americans Act Title VI Programs - Caregiver Focus Group	Form and Instruction	Removed	Title VI Caregiver Focus Group
227560	Evaluation of Older Americans Act Title VI Programs-Tribal Interview	Form	Removed	Tribal Elders Interview Consent Form
227560	Evaluation of Older Americans Act Title VI Programs-Tribal Interview	Form and Instruction	Removed	Title VI Tribal Elders Interview
227558	Evaluation of Older Americans Act Title VI - Tribal Elders Focus Group	Form	Removed	Tribal Elder Focus Group Consent Form
227558	Evaluation of Older Americans Act Title VI - Tribal Elders Focus Group	Form and Instruction	Removed	Title VI Elders Focus Group
227539	Evaluation of the Older Americans Title VI Programs - Other Program Staff - Interview	Form	Removed	Program Staff Interview Consent Form
227539	Evaluation of the Older Americans Title VI Programs - Other Program Staff - Interview	Form and Instruction	Removed	Title VI Other Program Staff Interview Guide
227538	Evaluation of Older Americans Act Title VI Program Staff-Focus Group	Form	Removed	Program Staff Focus Group Consent Form
227538	Evaluation of Older Americans Act Title VI Program Staff-Focus Group	Form and Instruction	Removed	Title VI Program Staff Focus Moderator Guide
227537	Evaluation of Older Americans Act Programs Title VI - Program Staff-Interviews	Form	Removed	Program Staff Interview Consent Form
227537	Evaluation of Older Americans Act Programs Title VI - Program Staff-Interviews	Form and Instruction	Removed	Title VI Program Staff Interview Guide

ICR Details

OMB Control No: 0985-0059	ICR Reference No: 201902-0985-001
Status: Historical Active	Previous ICR Reference No: 201707-0985-002
Agency/Subagency: HHS/ACL	Agency Tracking No:
Title: Annual Performance Reporting of the Administration for Community Living’s American Indian, Alaskan Natives and Native Hawaiian Programs
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: 04/05/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/07/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2022	36 Months From Approved	02/28/2021
Responses	507	0	345
Time Burden (Hours)	887	0	495
Cost Burden (Dollars)	0	0	0

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Abstract: The information submitted by Older Americans Act (OAA) Title VI grantees is AoA’s principle source of information on programs and services funded under the (OAA). The Program Performance Report (PPR) serves as the Program Performance Report for grantees to meet their annual grantee reporting requirements and includes the data required by the OAA to be reported in the AoA Annual Report to Congress. The data collection is summary data of services for seniors and family caregivers provided or managed by American Indian, Alaskan Native, and Native Hawaiian organizations. Data is submitted annually by all Title VI grantees. It includes information on the number of people served, the number of units of specific services, expenditures, and number of staff. Data from the PPR are the primary source for performance measures in the Congressional budget justification; the HHS Annual Performance Plan and Report as well as the Annual Report to Congress referred to above. AoA also uses the data to respond to inquiries from stakeholders, the public, and the press as well as program and policy decision makers.

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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:
	83 FR 40519	08/15/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 7379	03/04/2019
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

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
TITLE VI PROGRAM PERFORMANCE REPORT Part A/B	NA	Title VI PPR
TITLE VI PROGRAM PERFORMANCE REPORT Part C	NA	Title VI PPR Part C

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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	507	345	0	162	0	0
Annual Time Burden (Hours)	887	495	0	392	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: Changing Forms

Short Statement: These reporting requirements are a revision of those which are currently in effect under OMB 0985-0007. There is a program change increase from 2.5 hours for A/B and C to 3.5 hours per respondent, for a total increase of 392.5 annual burden hours. The factors that influenced the revision of the PPR include: 1) the need to modernize the data structure to allow for more efficient reporting and the ability to use current technology for reporting and analysis; 2) the interest in aligning data elements within and across data collections; 3) the need to consider alternative data elements that reflect the current Aging Network and long-term care services and supports; and 4) the need to enhance data quality.

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Annual Cost to Federal Government: $807,212

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: 03/07/2019

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