No Wrong Door System Management Tool

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
No Wrong Door Veteran Directed Care Tool	Form and Instruction	New	Available
No Wrong Door Management Data Colleciton and Entry Tool	Form and Instruction	New	Available
NWD 0985-New Supporting Statement.docx	Supporting Statement A	Uploaded 2019-03-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
234842	No Wrong Door System Management Tool-Veteran Directed	Form and Instruction	New	No Wrong Door Veteran Directed Care Tool
234839	No Wrong Door System Management Tool-State and Local Level	Form and Instruction	New	No Wrong Door Management Data Colleciton and Entry Tool

ICR Details

OMB Control No: 0985-0062	ICR Reference No: 201902-0985-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACL	Agency Tracking No:
Title: No Wrong Door System Management Tool
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 without change	Conclusion Date: 04/22/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/21/2019
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
Responses	6,904	0	0
Time Burden (Hours)	10,480	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the No Wrong Door System Management Tool (NWD MT) data collection is to provide a platform for documenting key elements that are necessary to evaluate the progress of the NWD System model and to understand and document the extent to which a state’s NWD System is streamlining and coordinating access to LTSS through four core functions of State Governance and Administration, Public Outreach and Coordination with Key Referral Sources, Person-Centered Counseling, and Streamlined Eligibility for Public Programs. In addition, the Veteran Directed Care (VDC) Tool will collect qualitative and quantitative data elements necessary to evaluate the impact of the VDC program. The NWD MT and VDC tool will track key performance measures and identify best practices and technical assistance needs.

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Authorizing Statute(s): PL: Pub.L. 109 - 365 202(b) Name of Law: Older Americans Act Amendments of 2006
  

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 55186	11/02/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 10098	03/19/2019
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
No Wrong Door System Management Tool-State and Local Level	NA	No Wrong Door Management Data Colleciton and Entry Tool
No Wrong Door System Management Tool-Veteran Directed	NA	No Wrong Door Veteran Directed Care Tool

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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	6,904	0	0	6,904	0	0
Annual Time Burden (Hours)	10,480	0	0	10,480	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 data collection, there is a program change increase of 10,480 annual burden hours.

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Annual Cost to Federal Government: $66,006

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: 03/21/2019

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