Fidelity Evaluation of the Administration for Community Livings Evidence-Based Programs

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Fidelity Evaluation-Site Survey	Form and Instruction	New	Available
Fidelity Evaluation-Grantee Survey	Form and Instruction	New	Available
Fidelity Evaluation of the Administration for Community Livings Evidence-Based Programs	Form and Instruction	New	Repair queued
New OMB Supporting Statement Part B - final v2.docx	Supporting Statement B	Uploaded 2021-11-17	Repair queued
New Fid OMB Supporting Statement Part A - final v2.docx	Supporting Statement A	Uploaded 2021-11-17	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
250380	Fidelity Evaluation of the Administration for Community Livings Evidence-Based Programs	Form and Instruction	New	Fidelity Evaluation-Site Survey
250380	Fidelity Evaluation of the Administration for Community Livings Evidence-Based Programs	Form and Instruction	New	Fidelity Evaluation-Grantee Survey
250380	Fidelity Evaluation of the Administration for Community Livings Evidence-Based Programs	Form and Instruction	New

ICR Details

OMB Control No: 0985-0073	ICR Reference No: 202111-0985-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/ACL	Agency Tracking No:
Title: Fidelity Evaluation of the Administration for Community Livings Evidence-Based Programs
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/26/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/18/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2025	36 Months From Approved
Responses	515	0	0
Time Burden (Hours)	445	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Administration for Community Living (ACL), within the U.S. Department of Health and Human Services (DHHS), supports the execution of the Fidelity Evaluation of ACL’s Evidence-Based Programs. ACL’s mission is to maximize the independence, well-being, and health of older adults and people with disabilities across their lifespan. ACL provides mandatory funding to 50 states and six U.S. territories (the District of Columbia, Puerto Rico, American Samoa, Guam, the Mariana Islands, and the Virgin Islands) under Title III-D of the Older Americans Act (OAA) (i.e., mandatory grantees), and also awards grants on a competitive basis to applicants who seek to promote the well-being of target populations through disease prevention and health promotion (i.e., discretionary grantees).

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Authorizing Statute(s): PL: Pub.L. 89 - 73 102 (14)(D)) Name of Law: Older Americans Act (OAA) of 1965, as amended
  

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 13720	07/12/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 24923	11/16/2021
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Fidelity Evaluation of the Administration for Community Livings Evidence-Based Programs	NA, NA	Fidelity Evaluation-Grantee Survey ,   Fidelity Evaluation-Site Survey

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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	515	0	0	515	0	0
Annual Time Burden (Hours)	445	0	0	445	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 information collection request there is a program change increase of 445 annual burden hours.

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Annual Cost to Federal Government: $397,722

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? 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: 11/18/2021

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