COVID-19 POST LEARNING COMMUNITY SURVEY

Forms and Documents

Document Name	Status
POST SURVEY ONLY Supporting Statement A_COVID-19 Learning Community.docx Supporting Statement A	2021-05-13
POST SURVEY ONLY Attachment A_Question by Question Source List_COVID-19.pdf Supplementary Document	2021-03-01
POST SURVEY ONLY COVID-19 Survey Instrument PRA.pdf Supplementary Document	2021-03-01
POST SURVEY ONLY Supporting statement B COVID 19 LC DR clean.docx Supporting Statement B	2021-03-01

IC Document Collections

IC ID	Document Title	Status
246054	COVID-19 POST LEARNING COMMUNITY SURVEY Other-Survey	New

ICR Details

OMB Control No:	ICR Reference No: 202102-0937-001
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/OASH	Agency Tracking No:
Title: COVID-19 POST LEARNING COMMUNITY SURVEY
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: 06/08/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	200	0
Time Burden (Hours)	17	0
Cost Burden (Dollars)	0	0

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Abstract: The Office of Minority Health (OMH) is seeking an approval from OMB on a new information collection, Advancing the Response to COVID-19 Learning Community Measure (hereafter COVID-19 Learning Community Measure). The purpose of this data collection is to gather quantitative and qualitative data from COBID-19 Learning Community members to the performance of the learning community in achieving process and outcome measures over the course of the one-year project. OMH will collect outcome measures from COVID-19 Learning Community members to assess the extent to which COVID-19 Learning Community members report that the learning community is effective in connecting subject matter experts and public health leaders, facilitating networking, and peer-to-peer information sharing of promising practices, programs, and/or policy.

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Authorizing Statute(s): None

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:
	86 FR 11306	02/24/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 29268	06/01/2021
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
COVID-19 POST LEARNING COMMUNITY SURVEY

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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	200	0	0	200	0	0
Annual Time Burden (Hours)	17	0	0	17	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: No

Burden Reduction Due to:

Short Statement: This is a new collection.

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Annual Cost to Federal Government: $40,400

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? Yes

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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: 06/08/2021

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