Capacity Building Assistance Program: Data Management, Monitoring, and Evaluation

Forms and Documents

Document Name	Status
Phone script -non-responders Form	New
Follow-up Survey Form	New
Post-TA evaluation Form	New
Post-training evaluation Form	New
Learning group registration Form	New
Att 16_Security Controls.docx Supplementary Document	2020-07-21
Att 14_Training and TA Follow-up Survey-Reminder Email.docx Supplementary Document	2020-07-21
Att 11_Training and TA Follow-up Survey Introductory Email Introductory Email.docx Supplementary Document	2020-07-21
Att 8_Post-Technical Assistance Evaluation Introductory Email.docx Supplementary Document	2020-07-21
Att 5_Post-Training Evaluation Introductory Email.docx Supplementary Document	2020-07-21
Att 2_60-Day FRN.pdf Supplementary Document	2020-07-20
Att 1_Auth Legislation.docx Supplementary Document	2020-07-20
Supporting Statement B.docx Supporting Statement B	2020-07-20
Supporting Statement A.docx Supporting Statement A	2020-07-20

IC Document Collections

IC ID	Document Title	Status
242741	Phone script -non-responders Form	New
242740	Follow-up Survey Form	New
242739	Post-TA evaluation Form	New
242738	Post-training evaluation Form	New
242737	Learning group registration Form	New

ICR Details

OMB Control No:	ICR Reference No: 202007-0920-013
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-20EU
Title: Capacity Building Assistance Program: Data Management, Monitoring, and Evaluation
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/03/2020

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	19,078	0
Time Burden (Hours)	1,671	0
Cost Burden (Dollars)	39,526	0

---

Abstract: The purpose of this information collection is to assess how well the Capacity Building Branch's Capacity Building Assistance (CBA) program meets the needs of its consumers in order to enhance its capacity building strategy over time. The information will be collected from recipients of CBA services (health professionals at CBOs and health departments). This assessment information will be used to improve program processes and operations.

---

Authorizing Statute(s): US Code: 42 USC 792 Name of Law: PHSA
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 4988	01/28/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 46631	08/03/2020
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Follow-up Survey	none, none	Follow-up Survey ,   Follow-up survey - word
Phone script -non-responders	none	Telephione script for non-responders
Learning group registration	none, noen	Learning group registration ,   Learning group registration - word
Post-training evaluation	none, none	Post-training evaluation ,   Post-training evaluation - word
Post-TA evaluation	none, none	Post-TA evaluation ,   Post-TA evaluation -word

---

ICR Summary of Burden

	Total Request	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	19,078	0	0	19,078	0	0
Annual Time Burden (Hours)	1,671	0	0	1,671	0	0
Annual Cost Burden (Dollars)	39,526	0	0	39,526	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: This is a new ICR.

---

Annual Cost to Federal Government: $844,155

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.     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.     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

---

Common Form ICR:  No

---

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: 08/03/2020

---