Family-to-Family Health Information Center (F2F HIC) Feedback Surveys

Forms and Documents

Document	Type	Status	Availability
Form 2 Family-to-Family Health Information Center Feedback Surveys	Form and Instruction	Modified	Repair queued
Form 1 Family-to-Family Health Information Centers Data Submission Form	Form and Instruction	Modified	Missing upstream
FeedbackSurvey_GrantRecipient_Instructions Final clean.docx	Supplementary Document	Uploaded 2022-01-18	Repair queued
Attachment - F2F 60 Day FRN.pdf	Supplementary Document	Uploaded 2022-01-18	Repair queued
Supporting Statement B Final.docx	Supporting Statement B	Uploaded 2022-01-18	Repair queued
Supporting Statement A Final.docx	Supporting Statement A	Uploaded 2022-01-18	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
234425	Family-to-Family Health Information Center Feedback Surveys	Form and Instruction	Modified
234424	Family-to-Family Health Information Centers Data Submission Form	Form and Instruction	Modified

ICR Details

OMB Control No: 0906-0040	ICR Reference No: 202201-0906-001
Status: Received in OIRA	Previous ICR Reference No: 201910-0906-002
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Family-to-Family Health Information Center (F2F HIC) Feedback Surveys
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 01/18/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved	03/31/2022
Responses	4,059	1,206
Time Burden (Hours)	5,851	5,423
Cost Burden (Dollars)	0	0

---

Abstract: The surveys will provide mechanisms to capture consistent, performance data; provide data to support the HHS Secretary's priorities of engagement; and allow HRSA to determine the extent to which F2F HICs provide service. F2F HICs can also use the data to evaluate the effectiveness of their interventions and improve services. Respondents are family members of children with special health care needs and professionals who serve such families.

---

Authorizing Statute(s): US Code: 42 USC 701(c) Name of Law: Social Security Act, Title V, 501(c)
   PL: Pub.L. 115 - 123 50501 Name of Law: Bipartisan Budget Act of 2018
   PL: Pub.L. 114 - 10 216 Name of Law: Medicare Access and CHIP Reautorization Act of 2015
  

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:
	86 FR 60260	11/01/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 2441	01/14/2022
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Family-to-Family Health Information Center Feedback Surveys	2	F2FHIC_Feedback Surveys Final clean.docx
Family-to-Family Health Information Centers Data Submission Form	1	Data Submission Final clean.docx

---

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	4,059	1,206	0	2,853	0	0
Annual Time Burden (Hours)	5,851	5,423	0	428	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: The increase in burden is a result of an increase in the number of respondents for the feedback survey, form #2.

---

Annual Cost to Federal Government: $52,578

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: 01/18/2022

---