Ryan White HIV/AIDS Program Allocation and Expenditure Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 5 EHE Allocations and Expenditures CLEAN.docx	Form and Instruction	Unchanged	Available
Form 5 EHE Expenditures Report	Form and Instruction	Unchanged	Repair queued
Form 4 EHE Allocations and Expenditures CLEAN.docx	Form and Instruction	Unchanged	Repair queued
Form 4 EHE Allocations Report	Form and Instruction	Unchanged	Repair queued
Form B-3 CLC_Part B_With Synchronization Warning.png	Form and Instruction	Unchanged	Available
Form B-3 CLC Form and Instruction for Part B	Form and Instruction	Unchanged	Repair queued
Form D-2 Part D COVID-19 Expenditures	Form	Unchanged	Repair queued
Form D-2 Part D Expenditures Report.docx	Form	Unchanged	Available
Form D-2 Part D Expenditures Report	Form	Unchanged	Repair queued
Form C-2 Part C COVID-19 Expenditures	Form	Unchanged	Available
Form C-2 Part C Expenditures Report.docx	Form	Unchanged	Repair queued
Form C-2 Part C Expenditures Report	Form	Unchanged	Repair queued
Form B-2 Part B Expenditures Report	Form	Modified	Repair queued
Form A-2 Part A COVID-19 Expenditures	Form	Unchanged	Repair queued
Form A-2 Part A Expenditures Report.docx	Form	Unchanged	Available
Form A-2 Part A Expenditures Report	Form	Unchanged	Repair queued
Form A-3 CLC_Part A.png	Form and Instruction	Unchanged	Available
Form A-3 CLC Form and Instruction for Part A	Form and Instruction	Unchanged	Repair queued
Form D-1 Part D COVID-19 Allocations	Form	Unchanged	Available
Form D-1 Part D Allocations Report.docx	Form	Unchanged	Available
Form D-1 Part D Allocations Report	Form	Unchanged	Repair queued
Form C-1 Part C COVID-19 Allocations	Form	Unchanged	Repair queued
Form C-1 Part C Allocations Report.docx	Form	Unchanged	Repair queued
Form C-1 Part C Allocations Report	Form	Unchanged	Repair queued
Form B-1 S Part B Allocations Report	Form	Modified	Available
Form A-1 Part A Allocations Report.docx	Form	Unchanged	Repair queued
Form A-1 Part A Allocations Report	Form	Unchanged	Repair queued
Form A-1 Part A COVID-19 Allocations	Form	Unchanged	Available
Change Memo - OMB Part B Supplemental Allocations Report and Consortia for CARES Act.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2021-03-03	Available
TAB B - 60-Day FRN.pdf	Supplementary Document	Uploaded 2020-06-26	Repair queued
FINAL A&E Supporting Statement.docx	Supporting Statement A	Uploaded 2020-08-26	Repair queued
Part A COVID-19 Expenditures markup copy to OMB.docx	Supplementary Document	Uploaded 2020-06-10	Repair queued
Part A COVID-19 Expenditures clean copy to OMB.docx	Supplementary Document	Uploaded 2020-06-10	Missing upstream
Part A COVID-19 Allocations markup copy for OMB.docx	Supplementary Document	Uploaded 2020-06-10	Missing upstream
Part A COVID-19 Allocations clean copy to OMB.docx	Supplementary Document	Uploaded 2020-06-10	Repair queued
Non Substantitive Change Memo HAB COVID-19 AE 20MAY2020.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-06-10	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
242547	EHE Expenditures Report	Form and Instruction	Unchanged	EHE Allocations and Expenditures CLEAN.docx
242547	EHE Expenditures Report	Form and Instruction	Unchanged
242545	EHE Allocations Report	Form and Instruction	Unchanged	EHE Allocations and Expenditures CLEAN.docx
242545	EHE Allocations Report	Form and Instruction	Unchanged
242544	CLC Form and Instruction for Part B	Form and Instruction	Unchanged	CLC_Part B_With Synchronization Warning.png
242544	CLC Form and Instruction for Part B	Form and Instruction	Unchanged
242479	Part D Expenditures Report	Form	Unchanged	Part D COVID-19 Expenditures
242479	Part D Expenditures Report	Form	Unchanged	Part D Expenditures Report.docx
242479	Part D Expenditures Report	Form	Unchanged
242478	Part C Expenditures Report	Form	Unchanged	Part C COVID-19 Expenditures
242478	Part C Expenditures Report	Form	Unchanged	Part C Expenditures Report.docx
242478	Part C Expenditures Report	Form	Unchanged
242476	Part B Expenditures Report	Form	Modified
242476	Part B Expenditures Report		Modified
242475	Part A Expenditures Report	Form	Unchanged	Part A COVID-19 Expenditures
242475	Part A Expenditures Report	Form	Unchanged	Part A Expenditures Report.docx
242475	Part A Expenditures Report	Form	Unchanged
226211	CLC Form and Instruction for Part A	Form and Instruction	Unchanged	CLC_Part A.png
226211	CLC Form and Instruction for Part A	Form and Instruction	Unchanged
183276	Part D Allocations Report	Form	Unchanged	Part D COVID-19 Allocations
183276	Part D Allocations Report	Form	Unchanged	Part D Allocations Report.docx
183276	Part D Allocations Report	Form	Unchanged
183275	Part C Allocations Report	Form	Unchanged	Part C COVID-19 Allocations
183275	Part C Allocations Report	Form	Unchanged	Part C Allocations Report.docx
183275	Part C Allocations Report	Form	Unchanged
183273	Part B Allocations Report	Form	Modified
183273	Part B Allocations Report		Modified
183271	Part A Allocations Report	Form	Unchanged	Part A Allocations Report.docx
183271	Part A Allocations Report	Form	Unchanged
183271	Part A Allocations Report	Form	Unchanged	Part A COVID-19 Allocations

ICR Details

OMB Control No: 0915-0318	ICR Reference No: 202103-0915-001
Status: Historical Active	Previous ICR Reference No: 202006-0915-006
Agency/Subagency: HHS/HSA	Agency Tracking No: 21434
Title: Ryan White HIV/AIDS Program Allocation and Expenditure Forms
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/10/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/03/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2023	09/30/2023	09/30/2023
Responses	1,336	0	1,336
Time Burden (Hours)	5,348	0	5,348
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

table that charts list of burden

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

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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	1,336	1,336	0	0	0	0
Annual Time Burden (Hours)	5,348	5,348	0	0	0	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: No

Burden Reduction Due to:

Short Statement:

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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: 03/03/2021

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