Ryan White HIV/AIDS Program Allocation and Expenditure Forms

Forms and Documents

Document Name	Status
Form 5 EHE Expenditures Report Form and Instruction	New
Form 4 EHE Allocations Report Form and Instruction	New
Form B-3 CLC Form and Instruction for Part B Form and Instruction	New
Form D-2 Part D Expenditures Report Form	New
Form C-2 Part C Expenditures Report Form	New
Form B-2 Part B Expenditures Report Form	New
Form A-2 Part A Expenditures Report Form	New
Form A-3 CLC Form and Instruction for Part A Form and Instruction	Modified
Form D-1 Part D Allocations Report Form	Modified
Form C-1 Part C Allocations Report Form	Modified
Form B-1 Part B Allocations Report Form	Modified
Form A-1 Part A Allocations Report Form	Modified
TAB B - 60-Day FRN.pdf Supplementary Document	2020-06-26
FINAL A&E Supporting Statement.docx Supporting Statement A	2020-08-26
Part A COVID-19 Expenditures markup copy to OMB.docx Supplementary Document	2020-06-10
Part A COVID-19 Expenditures clean copy to OMB.docx Supplementary Document	2020-06-10
Part A COVID-19 Allocations markup copy for OMB.docx Supplementary Document	2020-06-10
Part A COVID-19 Allocations clean copy to OMB.docx Supplementary Document	2020-06-10
Non Substantitive Change Memo HAB COVID-19 AE 20MAY2020.docx Justification for No Material/Nonsubstantive Change	2020-06-10

IC Document Collections

IC ID	Document Title	Status
242547	EHE Expenditures Report Form and Instruction	New
242545	EHE Allocations Report Form and Instruction	New
242544	CLC Form and Instruction for Part B Form and Instruction	New
242479	Part D Expenditures Report Form	New
242478	Part C Expenditures Report Form	New
242476	Part B Expenditures Report Form	New
242475	Part A Expenditures Report Form	New
226211	CLC Form and Instruction for Part A Form and Instruction	Modified
183276	Part D Allocations Report Form	Modified
183275	Part C Allocations Report Form	Modified
183273	Part B Allocations Report Form	Modified
183271	Part A Allocations Report Form	Modified

ICR Details

OMB Control No: 0915-0318	ICR Reference No: 202006-0915-006
Status: Active	Previous ICR Reference No: 202006-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No: 21434
Title: Ryan White HIV/AIDS Program Allocation and Expenditure Forms
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: 09/21/2020
	Date Received in OIRA: 07/02/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2023	36 Months From Approved	09/30/2020
Responses	1,336	0	1,242
Time Burden (Hours)	5,348	0	2,692
Cost Burden (Dollars)	0	0	0

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Abstract: Allocation and Expenditure Reports (A&E Reports) allow HRSA to monitor and track the use of grant funds for compliance with program and grants policies and requirements as outlined in the 2009 legislation. The A&E Forms collect financial information from grant recipients funded under Parts A, B, C, and D of the Ryan White HIV/AIDS Program (RWHAP).

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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:
	85 FR 7763	02/11/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 38382	06/26/2020
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 12

IC Title	Form No.	Form Name
EHE Expenditures Report	5	EHE Allocations and Expenditures CLEAN.docx
CLC Form and Instruction for Part A	A-3	CLC_Part A.png
Part A Allocations Report	A-1, A-1	Part A COVID-19 Allocations ,   Part A Allocations Report.docx
Part B Allocations Report	B-1, B-1	Part B COVID-19 Allocations ,   Part B Allocations Report.docx
Part C Allocations Report	C-1, C-1	Part C Allocations Report.docx ,   Part C COVID-19 Allocations
Part D Allocations Report	D-1, D-1	Part D Allocations Report.docx ,   Part D COVID-19 Allocations
Part A Expenditures Report	A-2, A-2	Part A COVID-19 Expenditures ,   Part A Expenditures Report.docx
Part B Expenditures Report	B-2, B-2	Part B Expenditures Report.pdf ,   Part B COVID-19 Expenditures
Part C Expenditures Report	C-2, C-2	Part C Expenditures Report.docx ,   Part C COVID-19 Expenditures
Part D Expenditures Report	D-2, D-2	Part D Expenditures Report.docx ,   Part D COVID-19 Expenditures
CLC Form and Instruction for Part B	B-3	CLC_Part B_With Synchronization Warning.png
EHE Allocations Report	4	EHE Allocations and Expenditures CLEAN.docx

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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	1,336	1,242	0	94	0	0
Annual Time Burden (Hours)	5,348	2,692	0	2,656	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: Yes

Burden Reduction Due to: Using Information Technology

Short Statement: Burden increase is a result of current recipients reporting a higher burden estimate than the previous recipients. The new EHE Allocations and Expenditures Reports added to this revision also increased the burden estimate. HRSA responded to an email from the lawyer representing the organization that sent the original comment.

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Annual Cost to Federal Government: $195,326

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? No

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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: 07/02/2020

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