Ryan White HIV/AIDS Program Allocation and Expenditure Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form A3 CLC	Form	Unchanged	Available
Form D2 Part D Expenditures Report 27FEB2017 Final.xlsx	Form	Unchanged	Available
Form D1 Part D Allocations Report 27FEB2017 Final.xlsx	Form	Unchanged	Available
Form C2 Part C Expendiutres Report.xlsx	Form	Unchanged	Available
Form C1 Part C Allocations Report.xlsx	Form	Unchanged	Available
Form 2 Part B Expenditures Report Suppl Expenditures_combined updated	Form	Unchanged	Available
Form 1 Part B Allocations Suppl Allocations Report_combined 13Mar2017_	Form	Unchanged	Available
Form B3 CLC	Form	Unchanged	Available
Form 2 Part A Expenditures Report 30MAR2017 Final	Form	Unchanged	Available
Form 1 Part A Allocations Report 30MAR2017 Final_modification	Form	Unchanged	Available
09150318 Allocations and Expenditures Mockup track changes.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2019-09-24	Available
FINALUSE Allocation and Expenditures EHE Non Substantitive Change 0915-DPD OGC to OAA cleancopy.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2019-09-24	Available
FINALUSE Allocation and Expenditures EHE Non Substantitive Change 0915-0318 OPAE track changes 9132019.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2019-09-24	Available
Supporting Statement A_FINAL.doc	Supporting Statement A	Uploaded 2017-03-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
226211	CLC Form and Instruction for Part A	Form	Unchanged	CLC
226211	CLC Form and Instruction for Part A	Instruction	Unchanged
183276	Part D Allocation and Expenditure forms	Form	Unchanged	Part D Expenditures Report 27FEB2017 Final.xlsx
183276	Part D Allocation and Expenditure forms	Form	Unchanged	Part D Allocations Report 27FEB2017 Final.xlsx
183275	Part C Allocation and Expenditure forms	Form	Unchanged	Part C Expendiutres Report.xlsx
183275	Part C Allocation and Expenditure forms	Form	Unchanged	Part C Allocations Report.xlsx
183275	Part C Allocation and Expenditure forms	Instruction	Unchanged
183273	Part B Allocation and Expenditure forms	Form	Unchanged	Part B Expenditures Report Suppl Expenditures_combined updated
183273	Part B Allocation and Expenditure forms	Form	Unchanged	Part B Allocations Suppl Allocations Report_combined 13Mar2017_
183273	Part B Allocation and Expenditure forms	Form	Unchanged	CLC
183273	Part B Allocation and Expenditure forms	Instruction	Unchanged
183271	Part A Allocation and Expenditures Forms	Form	Unchanged	Part A Expenditures Report 30MAR2017 Final
183271	Part A Allocation and Expenditures Forms	Form	Unchanged	Part A Allocations Report 30MAR2017 Final_modification
183271	Part A Allocation and Expenditures Forms	Instruction	Unchanged

ICR Details

OMB Control No: 0915-0318	ICR Reference No: 201909-0915-004
Status: Historical Active	Previous ICR Reference No: 201709-0915-003
Agency/Subagency: HHS/HSA	Agency Tracking No: 21434
Title: Ryan White HIV/AIDS Program Allocation and Expenditure Forms
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/12/2019
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/25/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2020	07/31/2020	07/31/2020
Responses	1,242	0	1,242
Time Burden (Hours)	2,692	0	2,692
Cost Burden (Dollars)	0	0	0

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Abstract: HRSA’s HIV/AIDS Bureau (HAB) administers the Ryan White HIV/AIDS Program authorized under Title XXVI of the Public Health Service Act as amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009. The purpose of the legislation is to provide emergency assistance to localities that are disproportionately affected by the human immunodeficiency virus (HIV) epidemic and to make financial assistance available for the development, organization, coordination, and operation of more effective and cost-efficient systems for the delivery of essential services to persons with HIV. It also provides grants to states for the delivery of services to HIV positive individuals and their families. Under the law, recipients receiving funds under Parts A, B, and C must spend at least 75 percent of funds on “core medical services.” The proposed forms will collect information from recipients documenting the use of funds to ensure compliance with the Act.

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Authorizing Statute(s): PL: Pub.L. 109 - 415 105 Name of Law: Ryan White HIV/AIDS Treatment Modernization Act 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:
	82 FR 6578	01/19/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 15227	03/27/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
CLC Form and Instruction for Part A	A3	CLC
Part A Allocation and Expenditures Forms	1, 2	Part A Allocations Report 30MAR2017 Final_modification ,   Part A Expenditures Report 30MAR2017 Final
Part B Allocation and Expenditure forms	1, B3, 2	CLC ,   Part B Allocations Suppl Allocations Report_combined 13Mar2017_ ,   Part B Expenditures Report Suppl Expenditures_combined updated
Part C Allocation and Expenditure forms	C1, C2	Part C Allocations Report.xlsx ,   Part C Expendiutres Report.xlsx
Part D Allocation and Expenditure forms	D1, D2	Part D Allocations Report 27FEB2017 Final.xlsx ,   Part D Expenditures Report 27FEB2017 Final.xlsx

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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	1,242	1,242	0	0	0	0
Annual Time Burden (Hours)	2,692	2,692	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: $81,823

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: 09/25/2019

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