Annual Performance Report for the State Grant for Assistive Technology Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Statewide AT Annual Performance Measurements Report	Form	Removed	Repair queued
Statewide AT Customer Satisfaction Survey	Form and Instruction	Removed	Repair queued
Annual Performance Report for the State Grant for Assistive Technology Program	Form and Instruction	New	Repair queued
Form 1 Record Keeping Burden	Form	Removed	Available
Form 1 Program Support	Form	Removed	Repair queued
Form 1 Annual Report for the State Grant for Assistive Technology Program	Form	Removed	Missing upstream
0042 Public Comment Summary for AT APR-IC Nov 27 2020.xlsx	Supplementary Document	Uploaded 2021-01-08	Repair queued
0042 Supporting Statement for AT APR 121420 Reinstate w Change.docx	Supporting Statement A	Uploaded 2021-01-08	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
46672	Statewide AT Annual Performance Measurements Report	Form	Removed
46671	Statewide AT Customer Satisfaction Survey	Form and Instruction	Removed
245267	Annual Performance Report for the State Grant for Assistive Technology Program	Form and Instruction	New
228667	Record Keeping Burden	Form	Removed
228666	Program Support	Form	Removed
21562	Annual Report for the State Grant for Assistive Technology Program	Form	Removed

ICR Details

OMB Control No: 0985-0042	ICR Reference No: 202012-0985-001
Status: Received in OIRA	Previous ICR Reference No: 201710-0985-003
Agency/Subagency: HHS/ACL	Agency Tracking No:
Title: Annual Performance Report for the State Grant for Assistive Technology Program
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 01/11/2021

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	56	0
Time Burden (Hours)	22,624	0
Cost Burden (Dollars)	0	0

---

Abstract: The Administration for Community Living (ACL) of the U.S. Department of Health and Human Services (HHS) requests clearance for the reinstatement with change of a data collection instrument, Office of Management and Budget (OMB) Control Number 0985-0042, to be completed by grantees under the Assistive Technology Act of 1998, as amended (Public Law 108-364). The information collected through this data collection instrument is necessary for ACL and states to comply with Sections 4 and 7 of the Assistive Technology Act of 1998, as amended (AT Act). ACL is requesting a reinstatement with change of the annual data collection instrument (OMB No. 0985-0042). Section 4 Requirements Necessitating Data Collection Section 4 of the AT Act authorizes grants to public agencies in the 50 states and the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Marianas (states and outlying areas). With these funds, the 56 states and outlying areas operate “Statewide AT Programs” that conduct activities to increase access to and acquisition of assistive technology (AT) for individuals with disabilities and older Americans. These comprehensive activities are divided into two categories: “State-level Activities” and “State Leadership Activities.” According to Section 4 of the AT Act, as a condition of receiving a grant to support their Statewide AT Programs, the 56 states and outlying areas must provide to ACL: (1) applications and (2) annual progress reports on their activities. Applications: The application required of states and outlying areas is a three-year State Plan for Assistive Technology (State Plan for AT or State Plan) (OMB No. 0985-0048). The content of the State Plan for AT is based on the requirements in Section 4(d) of the AT Act. As a part of this State Plan, Section 4(d)(3) of the AT Act requires that states and outlying areas set measurable goals for addressing the assistive technology needs of individuals with disabilities in education, employment, community living and information technology/telecommunications. Every state and outlying area is required to include a minimum of seven prescribed measurable goals in its State Plan. These seven goals apply to all states and outlying areas in order to aggregate information on performance of the program at the national level. National aggregation of data related to these goals is necessary for the Government Performance and Results Modernization Act of 2010 (GPRAMA) (Public Law 111-352), as well as an Annual Report to Congress (see “Section 7 Requirements Necessitating Collection” below). Therefore, this data collection instrument provides a way for all 56 grantees—50 U.S. states, D.C., Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands to collect and report data on their performance in a consistent manner, including a uniform survey to be given to consumers. This uniform survey is included as part of the data collection package. Annual Reports: In addition to submitting a State Plan every three years, states and outlying areas are required to submit annual progress reports on their activities. The data required in that progress report is specified in Section 4(f) of the AT Act. Section 7 Requirements Necessitating Collection Section 7(d) of the AT Act requires that ACL submit to Congress an annual report on the activities conducted under the Act and an analysis of the progress of the states and outlying areas in meeting their measurable goals. This report must include a compilation and summary of the data collected under Section 4(f). In order to make this possible, states and outlying areas must provide their data uniformly. This data collection instrument was developed to ensure that all 56 states and outlying areas report data in a consistent manner in alignment with the requirements of Section 4(f).

---

Authorizing Statute(s): PL: Pub.L. 108 - 364 4 Name of Law: Assistive Technology Act of 1998, as amended
  

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 6083	09/28/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 310	01/05/2021
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Statewide AT Customer Satisfaction Survey	NA	SGAT Customer Survey
Record Keeping Burden	1	State Grant for AT Progress Report
Annual Performance Report for the State Grant for Assistive Technology Program	NA	Annual Performance Report for the State Grant for Assistive Technology Program
Statewide AT Annual Performance Measurements Report	N/A	State Assessment and Performance Measurement Form
Annual Report for the State Grant for Assistive Technology Program	1	State Grant AT Annual Progress Report
Program Support	1	State Grant for AT Annual Progres Report

---

ICR Summary of Burden

table that charts list 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	56	0	0	-6,596	0	6,652
Annual Time Burden (Hours)	22,624	0	0	0	0	22,624
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: Miscellaneous Actions

Short Statement: This is a reinstatement with change, there is a program change increase of 22,624 annual burden hours.

---

Annual Cost to Federal Government: $186,626

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

---

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: 01/11/2021

---