Performance Monitoring of “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Youth Serving Organization (YSO) Staff Survey	Form and Instruction	Removed	Available
Att 11a YSO Performance Measure Reporting Tool Online Version	Form	Removed	Available
Att 9a YSO Organizational Assessment Online Version	Form	Removed	Available
Form 0920-1156 Health Center Provider Survey Online	Form and Instruction	Modified	Available
Form 0920-1156 Health Center Provider Survey	Form and Instruction	Modified	Available
Form 0920-1156 Annual Health Center Performance Measure Reporting Tool Online	Form and Instruction	Modified	Available
Form 0920-1156 Annual Health Center Perfornce Meure Repting Tool	Form and Instruction	Modified	Available
Form 0920-1156 Quarterly Health Center Performance Measure Reporting Tool Online	Form and Instruction	Modified	Available
Form 0920-1156 Quarterly Health Center Performance Measure Reporting Tool	Form and Instruction	Modified	Available
Form 0920-1156 Health Center Org Assessment Online	Form and Instruction	Modified	Available
Form 0920-1156 Health Center Org Assessment	Form and Instruction	Modified	Available
Helath Center Youth Survey	Form and Instruction	Removed	Available
Form 0920-1156 Awardee Performance Measure Reporting Tool Online	Form and Instruction	Modified	Available
Form 0920-1156 Awardee Performance Measure Reporting Tool	Form and Instruction	Modified	Available
Form 0920-1156 Awardee Training and Technical Assistance Tool	Form and Instruction	Modified	Available
Att 10a YSO Staff Survey Online Version	Form	Removed	Available
Att 10 YSO Staff Survey clean	Form and Instruction	Removed	Available
Youth Serving Organization Performance Measure Reporting Tool	Form and Instruction	Removed	Available
Att 6a Health Center Youth Survey Online Version	Form	Removed	Repair queued
Att 6a Health Center Youth Survey Online Version	Form and Instruction	Removed	Available
Form 0920-1156 Health Center Provider Survey Online	Form and Instruction	Modified	Available
Form 0920-1156 Health Center Provider Survey	Form and Instruction	Modified	Repair queued
Form 0920-1156 Annual Health Center Performance Measure Reporting Tool Online	Form and Instruction	Modified	Available
Form 0920-1156 Annual Health Center Performance Measure Reporting Tool	Form and Instruction	Modified	Available
Form 0920-1156 Quarterly Health Center Performance Measure Reporting Tool Online	Form and Instruction	Modified	Available
Form 0920-1156 Quarterly Health Center Performance Measure Reporting Tool	Form and Instruction	Modified	Available
Form 0920-1156 Health Center Org Assessment Online	Form and Instruction	Modified	Available
Form 0920-1156 Health Center Org Assessment	Form and Instruction	Modified	Available
Research Determination Teen Preg Final.pdf	Supplementary Document	Uploaded 2020-01-24	Available
Att 10a 60 day Federal Register Notice.pdf	Supplementary Document	Uploaded 2020-01-24	Available
Att 9 logic model.docx	Supplementary Document	Uploaded 2020-01-24	Available
Att 2 Crosswalk of Objectives and Data Sources_080219.docx	Supplementary Document	Uploaded 2020-01-24	Available
Att 1-Authorizing Legislation.pdf	Supplementary Document	Uploaded 2020-01-24	Available
SSB Working with Public Centers Teen Preg ICRO Final.docx	Supporting Statement B	Uploaded 2020-01-24	Available
SSA Working with Public Centers Teen Preg ICRO Final.docx	Supporting Statement A	Uploaded 2020-01-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
222392	Youth Serving Organization (YSO) Staff Survey	Form and Instruction	Removed	Youth Serving Organization (YSO) Staff Survey
222389	Youth Serving Organization (YSO) Performance Measure Reporting Tool	Form	Removed	Att 11a YSO Performance Measure Reporting Tool Online Version
222387	Youth Serving Organization (YSO) Organizational Assessment	Form	Removed	Att 9a YSO Organizational Assessment Online Version
222386	Health Center Provider Survey	Form and Instruction	Modified	Health Center Provider Survey Online
222386	Health Center Provider Survey	Form and Instruction	Modified	Health Center Provider Survey
222376	Annual Health Center Performance Measure Reporting Tool	Form and Instruction	Modified	Annual Health Center Performance Measure Reporting Tool Online
222376	Annual Health Center Performance Measure Reporting Tool	Form and Instruction	Modified	Annual Health Center Perfornce Meure Repting Tool
222375	Quarterly Health Center Perfoemance Measure Reporting Tool	Form and Instruction	Modified	Quarterly Health Center Performance Measure Reporting Tool Online
222375	Quarterly Health Center Perfoemance Measure Reporting Tool	Form and Instruction	Modified	Quarterly Health Center Performance Measure Reporting Tool
222374	Health Center Organizational Assessment	Form and Instruction	Modified	Health Center Org Assessment Online
222374	Health Center Organizational Assessment	Form and Instruction	Modified	Health Center Org Assessment
222373	Health Center Youth Survey	Form and Instruction	Removed	Helath Center Youth Survey
222372	Awardee Performance Measure Reporting Tool	Form and Instruction	Modified	Awardee Performance Measure Reporting Tool Online
222372	Awardee Performance Measure Reporting Tool	Form and Instruction	Modified	Awardee Performance Measure Reporting Tool
222371	Awardee Training and Techmnical Assistance Tool	Form and Instruction	Modified	Awardee Training and Technical Assistance Tool
222370	Youth Serving Organization (YSO) Staff Survey	Form	Removed	Att 10a YSO Staff Survey Online Version
222370	Youth Serving Organization (YSO) Staff Survey	Form and Instruction	Removed	Att 10 YSO Staff Survey clean
222369	Youth Serving Organization (YSO) Performance Measure Reporting Tool	Form and Instruction	Removed	Youth Serving Organization Performance Measure Reporting Tool
222368	Youth Serving Organization (YSO) Organizational Assessment	Form	Removed	Att 6a Health Center Youth Survey Online Version
222368	Youth Serving Organization (YSO) Organizational Assessment	Form and Instruction	Removed	Att 6a Health Center Youth Survey Online Version
222367	Health Center Provider Survey	Form and Instruction	Modified	Health Center Provider Survey Online
222367	Health Center Provider Survey	Form and Instruction	Modified	Health Center Provider Survey
222366	Annual Health Center Performance Measure Reporting Tool	Form and Instruction	Modified	Annual Health Center Performance Measure Reporting Tool Online
222366	Annual Health Center Performance Measure Reporting Tool	Form and Instruction	Modified	Annual Health Center Performance Measure Reporting Tool
222365	Quarterly Health Center Performance Measure Reporting Tool	Form and Instruction	Modified	Quarterly Health Center Performance Measure Reporting Tool Online
222365	Quarterly Health Center Performance Measure Reporting Tool	Form and Instruction	Modified	Quarterly Health Center Performance Measure Reporting Tool
222364	Health Center Organizational Assessment	Form and Instruction	Modified	Health Center Org Assessment Online
222364	Health Center Organizational Assessment	Form and Instruction	Modified	Health Center Org Assessment

ICR Details

OMB Control No: 0920-1156	ICR Reference No: 201912-0920-012
Status: Historical Active	Previous ICR Reference No: 201703-0920-010
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1156
Title: Performance Monitoring of “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/28/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/27/2020
Terms of Clearance: Previous terms continue: Approved consistent with the understanding that this collection will measure outcomes intended to facilitate program improvement and development. Collection activities are not intended to produce generalizable outcomes regarding teen pregnancy or reproductive health.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2021	8 Months From Approved	04/30/2020
Responses	227	0	2,064
Time Burden (Hours)	485	0	1,150
Cost Burden (Dollars)	0	0	0

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Abstract: The goal of the study is to evaluate and improve efforts of three awardees funded to work with health centers to enhance implementation of best practices in adolescent reproductive health care. Information collected will be used to continue monitoring awardee performance and determine training and technical assistance. Awardees will continue to conduct assessments of health center organizations, surveys of providers at the health center partner organizations, as well as report on their own activities. This is a request for a Revision of a currently approved data collection (Exp. 1/31/2020) to continue data collection for health center partners and awardees until the end of the funding period (9/30/2020).

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

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 46733	09/05/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 3921	01/23/2020
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
Annual Health Center Performance Measure Reporting Tool	0920-1156, 0920-1156	Annual Health Center Performance Measure Reporting Tool ,   Annual Health Center Performance Measure Reporting Tool Online
Annual Health Center Performance Measure Reporting Tool	0920-1156, 0920-1156	Annual Health Center Perfornce Meure Repting Tool ,   Annual Health Center Performance Measure Reporting Tool Online
Awardee Performance Measure Reporting Tool	0920-1156, 0920-1156	Awardee Performance Measure Reporting Tool ,   Awardee Performance Measure Reporting Tool Online
Awardee Training and Techmnical Assistance Tool	0920-1156	Awardee Training and Technical Assistance Tool
Health Center Organizational Assessment	0920-1156, 0920-1156	Health Center Org Assessment ,   Health Center Org Assessment Online
Health Center Organizational Assessment	0920-1156, 0920-1156	Health Center Org Assessment ,   Health Center Org Assessment Online
Health Center Provider Survey	0920-1156, 0920-1156	Health Center Provider Survey ,   Health Center Provider Survey Online
Health Center Provider Survey	0920-1156, 0920-1156	Health Center Provider Survey ,   Health Center Provider Survey Online
Health Center Youth Survey	NA	Helath Center Youth Survey
Quarterly Health Center Perfoemance Measure Reporting Tool	0920-1156, 0920-1156	Quarterly Health Center Performance Measure Reporting Tool ,   Quarterly Health Center Performance Measure Reporting Tool Online
Quarterly Health Center Performance Measure Reporting Tool	0920-1156, 0920-1156	Quarterly Health Center Performance Measure Reporting Tool ,   Quarterly Health Center Performance Measure Reporting Tool Online
Youth Serving Organization (YSO) Organizational Assessment	N/A, N/A	Att 6a Health Center Youth Survey Online Version ,   Att 6a Health Center Youth Survey Online Version
Youth Serving Organization (YSO) Organizational Assessment	N/A	Att 9a YSO Organizational Assessment Online Version
Youth Serving Organization (YSO) Performance Measure Reporting Tool	N/A	Att 11a YSO Performance Measure Reporting Tool Online Version
Youth Serving Organization (YSO) Performance Measure Reporting Tool	NA	Youth Serving Organization Performance Measure Reporting Tool
Youth Serving Organization (YSO) Staff Survey	N/A, N/A	Att 10 YSO Staff Survey clean ,   Att 10a YSO Staff Survey Online Version
Youth Serving Organization (YSO) Staff Survey	NA	Youth Serving Organization (YSO) Staff Survey

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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	227	2,064	0	-87	-1,750	0
Annual Time Burden (Hours)	485	1,150	0	-140	-525	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The program is not collecting information from the Youth Serving Organization instruments for this "extension" period.

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Annual Cost to Federal Government: $1,444,310

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 01/27/2020

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