The HRSA Community Based Outreach Reporting Module

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3 General Outreach Activities for Community Members Form	Form and Instruction	New	Available
Form 2 Vaccine Site Data - Outreach to Community Members Form	Form and Instruction	New	Available
Form 1 Community Outreach Worker Profile Form	Form and Instruction	New	Available
Transmittal Memo to OIRA from HRSA CBO PRA Approval Request 07.09.2021 approved.pdf	Supplementary Document	Uploaded 2021-07-09	Available
Supporting Statement - CBO Program_07Jul2021.docx	Supporting Statement A	Uploaded 2021-07-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
248292	General Outreach Activities for Community Members Form	Form and Instruction	New
248291	Vaccine Site Data - Outreach to Community Members Form	Form and Instruction	New
248288	Community Outreach Worker Profile Form	Form and Instruction	New

ICR Details

OMB Control No: 0906-0064	ICR Reference No: 202107-0906-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: The HRSA Community Based Outreach Reporting Module
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 07/23/2021
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/12/2021
	Date Received in OIRA: 07/12/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2022	6 Months From Approved
Responses	8,003,000	0	0
Time Burden (Hours)	934,134	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: HRSA requests approval to collect program data on its Community-Based Workforce for COVID-19 Vaccine Outreach Programs (CBO Programs), which support nonprofit private or public organizations to establish, expand, and sustain a public health workforce to prevent, prepare for, and respond to COVID-19. This data is needed to comply with requirements to monitor funds distributed under the American Rescue Plan and OMB Memo 21-20.

Emergency Justfication: Per OMB memo M-21-20, the American Rescue Plan Act (ARP) provides critical resources to respond to the public health crisis the Nation faces as a result of the COVID-19 pandemic, and specifically to support community vaccination and address health disparities. The memo emphasizes the need for a swift Government-wide response, to ensure the public’s trust in how the Federal Government implements ARP programs and distributes ARP funding, and to optimize the accountability and transparency of Federal Government spending and achieving results are necessary for effective stewardship of these funds. To this end, federal awarding agencies must collect recipient performance reports in a manner that enables the Federal Government to articulate the outcomes of Federal financial assistance to the American people, collect performance information that measures progress in achieving program goals and objectives, ensures payment integrity, and demonstrating equity-oriented results – all while minimizing the reporting burden to Federal financial assistance recipients. Because of the urgent nature of the COVID-19 pandemic response, combined with the quick disbursement of and the short-term duration of this funding (one time disbursement of 6-month and 12-month funds), it is important for HRSA to obtain data as quickly as possible as of the date of this request. The data will allow HRSA to ensure that funding recipients are meeting the terms and conditions of their funding, while providing HRSA with information on the effectiveness of funds distributed through this program. HRSA intends to start requiring data collection as soon as possible, no later than August 1, 2021. HRSA is putting forth this emergency information collection request in June 2021, so that the data collection plan will be clearly articulated in the notice of funding awards for this program that will be released on July 27, 2021. This will ensure that the data collection requirement for awardees will begin immediately upon the release of program funds. Since the fiscal year 2021 moneys are supporting this program and need to be distributed as quickly as possible, and due to the COVID–19 public health crisis, there was insufficient time to design an evaluation strategy specifying metrics and data collection methods prior to the release of funds.

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Authorizing Statute(s): PL: Pub.L. 117 - 2 0 Name of Law: American Rescue Plan Act of 2021
  

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

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Community Outreach Worker Profile Form	1	Community Outreach Worker Profile Form
General Outreach Activities for Community Members Form	3	General Outreach Activities for Community Members Form
Vaccine Site Data - Outreach to Community Members Form	2	Vaccine Site Data - Outreach to Community Members Form

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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	8,003,000	0	0	8,003,000	0	0
Annual Time Burden (Hours)	934,134	0	0	934,134	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 ICR, so burden increases from zero (0).

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Annual Cost to Federal Government: $34,906

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? 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: 07/12/2021

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