OS Think Cultural Health

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
30-day FRN 0990-0407.pdf	Supplementary Document	Uploaded 2019-04-30	Available
SS_A 0990-0407 OS Think Cultural Health.doc	Supporting Statement A	Uploaded 2019-04-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
219188	Key Informant interview-Community Health Workers	Other-interview	Unchanged
219187	Key Informant interview	Other-interview	Unchanged
219186	Focus Groups- Health and Health Care	Other-Focus Group	Unchanged
219185	Follow-up Survey -Community Health workers	Other-forms	Unchanged
219184	Follow-up Survey -Health and Healthcare Professionals	Other-forms	Unchanged
219105	TCH Course/Unit Evaluation Form	Other-Course	Unchanged
219104	TCH Registration Form	Other-form	Unchanged

ICR Details

OMB Control No: 0990-0407	ICR Reference No: 201904-0990-002
Status: Active	Previous ICR Reference No: 201511-0990-001
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: OS Think Cultural Health
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/07/2019
	Date Received in OIRA: 04/30/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2022	36 Months From Approved	06/30/2019
Responses	23,193	0	23,193
Time Burden (Hours)	2,032	0	2,032
Cost Burden (Dollars)	0	0	0

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Abstract: The Office of Minority Health (OMH), Office of the Secretary (OS), Department of Health and Human Services (HHS) is requesting approval from OMB to revise a currently approved collection with OMB number 0990-0407 to cover routine data collection activities to be collected directly from respondents who complete an online registration form in order to receive access to e-resources, e-learning programs, and/or “Join the CLCCHC” offered on the Think Cultural Health (TCH) website

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Authorizing Statute(s): PL: Pub.L. 111 - 148 5307 Name of Law: Patient Protection and Affordable Care Act of 2010
  

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:
	84 FR 6795	02/28/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 18291	04/30/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
Follow-up Survey -Health and Healthcare Professionals
Follow-up Survey -Community Health workers
TCH Registration Form
Focus Groups- Health and Health Care
Key Informant interview
Key Informant interview-Community Health Workers
TCH Course/Unit Evaluation 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	23,193	23,193	0	0	0	0
Annual Time Burden (Hours)	2,032	2,032	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: $21,500

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.     Yes

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.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

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: 04/30/2019

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