HIV Quality Measures Performance Measure Module (HIVQM Module)

Forms and Documents

Document Name	Status
Form 1 HIV Quality Measures Performance Measure Module (HIVQM Module) Form	Modified
FINAL Supporting Statement A.docx Supporting Statement A	2019-12-19

IC Document Collections

IC ID	Document Title	Status
222138	HIV Quality Measures Performance Measure Module (HIVQM Module) Form	Modified

ICR Details

OMB Control No: 0906-0022	ICR Reference No: 201909-0906-002
Status: Active	Previous ICR Reference No: 201606-0906-002
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: HIV Quality Measures Performance Measure Module (HIVQM Module)
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: 12/23/2019
	Date Received in OIRA: 09/09/2019
Terms of Clearance: Approved consistent with the understanding that HRSA will consider ways to integrate and harmonize data collection activities associated with the Ryan White HIV/AIDS Program.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2022	36 Months From Approved	12/31/2019
Responses	9,264	0	6,948
Time Burden (Hours)	55,584	0	6,948
Cost Burden (Dollars)	0	0	0

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Abstract: Information collected will be used to continually monitor and evaluate HIV Performance Measures for Ryan White HIV/AIDS Program recipients. The aggregate data collected will also be critical to ensuring that HRSA can continue to respond to requests from the Secretary of the DHHS, Congress and other stakeholders. Recipients entering data will be health facilities who provide HIV care services to HIV-infected patients.

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Authorizing Statute(s): PL: Pub.L. 111 - 87 0 Name of Law: Ryan White 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 9362	03/14/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 44623	08/26/2019
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
HIV Quality Measures Performance Measure Module (HIVQM Module)	1	Draft Manual

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ICR Summary 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	9,264	6,948	0	0	2,316	0
Annual Time Burden (Hours)	55,584	6,948	0	0	48,636	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: The burden has increased due to an increase in average burden per response. It has increased from 1 to 6 this submission.

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Annual Cost to Federal Government: $140,800

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: 09/09/2019

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