Assessing Care and Health Outcomes Among Ryan White HIV/AIDS Program (RWHAP) Clients Who Do Not Receive RWHAP-Funded Outpatient Ambulatory Health Services (Non-OAHS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 5 Telephone Screening	Form and Instruction	New	Available
Form 3 Medical Record Abstraction	Form and Instruction	New	Available
Form 2 Client Interview Protocol	Form and Instruction	New	Available
Form 1 Provider Interview Protocol	Form and Instruction	New	Available
Attachment A8 - Type 2 Provider Intro Slides.pptx	Supplementary Document	Uploaded 2019-07-11	Available
Attachment A7 - Type 1 Provider Intro Slides.pptx	Supplementary Document	Uploaded 2019-07-11	Available
Attachment A6 - Introduction Letter.docx	Supplementary Document	Uploaded 2019-07-11	Available
Attachment A5 - Fact_Sheet_Client.docx	Supplementary Document	Uploaded 2019-07-11	Available
Attachment A4 - Fact_Sheet_Type_2_non-RWHAP_Clinical.docx	Supplementary Document	Uploaded 2019-07-11	Available
Attachment A3 - Fact_Sheet_Type_1_RWHAP_Clinical_Yes_OAHS.docx	Supplementary Document	Uploaded 2019-07-11	Available
Attachment A2 - Fact_Sheet_Type_1_RWHAP_Clinical_No_OAHS.docx	Supplementary Document	Uploaded 2019-07-11	Available
Attachment A1 - Fact_Sheet_Type_1_RWHAP_Non-Clinical_No_OAHS.docx	Supplementary Document	Uploaded 2019-07-11	Available
REVISEDFINALSupporting Statement B revised_11_5_post_omb_ convo_CLEAN.docx	Supporting Statement B	Uploaded 2019-12-12	Available
REVISEDFINALSupporting Statement A_revised_12_2_2019.docx	Supporting Statement A	Uploaded 2019-12-12	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
236874	Telephone Screening	Form and Instruction	New
236873	Medical Record Abstraction	Form and Instruction	New
236872	Client Interview Protocol	Form and Instruction	New
236870	Provider Interview Protocol	Form and Instruction	New

ICR Details

OMB Control No: 0906-0046	ICR Reference No: 201907-0906-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Assessing Care and Health Outcomes Among Ryan White HIV/AIDS Program (RWHAP) Clients Who Do Not Receive RWHAP-Funded Outpatient Ambulatory Health Services (Non-OAHS)
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 with change	Conclusion Date: 12/12/2019
	Date Received in OIRA: 07/11/2019
Terms of Clearance: Approved consistent with the understanding that HHS/HRSA will consider ways to integrate and harmonize data collection activities associated with the Ryan White HIV/AIDS Program.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2022	36 Months From Approved
Responses	1,765	0	0
Time Burden (Hours)	292	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: HRSA is conducting this study to understand the quality of care and viral suppression rate among the approximately 165,000 RWHAP clients for whom it does not collect clinical information. HRSA will use the findings to (1) assess care and health outcomes among its non-medical clients; (2) determine if and where these clients receive medical care; (3) identify unmet needs faced by this population; and (4) develop strategies to strengthen the coordination of services between RWHAP-funded and nonfunded providers and, thus, improve retention in care and viral suppression for all of its clients.

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Authorizing Statute(s): PL: Pub.L. 111 - 87 0 Name of Law: Title XSXVI PHSA as amended by RW HIV/AIDS Treatment Extension Act of 2009
  

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 13934	04/08/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 32752	07/09/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Telephone Screening	5	Attachment D - Telephone_Screener.docx
Provider Interview Protocol	1	B1 Provder Interview Protocols
Medical Record Abstraction	3, 4	Attachment C1 - Medical_Record_Abstraction_long.xlsm ,   Attachment C2 - Medical_Record_Astraction_short.xlsm
Client Interview Protocol	2	Attachment B2 - Client_Interview_Protocols.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	1,765	0	0	1,765	0	0
Annual Time Burden (Hours)	292	0	0	292	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: As this is a new ICR, this is an increase from zero (0) to 292 total burden hours.

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Annual Cost to Federal Government: $1,170,962

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]? 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: 07/11/2019

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