"HIV Prevention Capacity Development Needs Assessments of Federally funded Health Departments and Community-based Organizations

Forms and Documents

Document Name	Status
Form 0920- Health Department Needs Assessment Form and Instruction	New
Form 0920- Community-Based Organizations Needs Assessment Form and Instruction	New
Att 6_NCHHSTP_Project Determination_Needs Assessments.docx Supplementary Document	2022-01-28
Att 5 PIA CTS.pdf Supplementary Document	2022-01-28
Att 4_Security Controls.docx Supplementary Document	2022-01-28
Att 3d_Email Notifications.docx Supplementary Document	2022-01-28
Att 1_Auth Legislation.docx Supplementary Document	2022-01-28
SSB.011322.docx Supporting Statement B	2022-01-28
SSA. (011322).docx Supporting Statement A	2022-01-28

IC Document Collections

IC ID	Document Title	Status
251349	Health Department Needs Assessment Form and Instruction	New
251348	Community-Based Organizations Needs Assessment Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202201-0920-008
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-21HU
Title: "HIV Prevention Capacity Development Needs Assessments of Federally funded Health Departments and Community-based Organizations
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: 02/17/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	200	0
Time Burden (Hours)	66	0
Cost Burden (Dollars)	0	0

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Abstract: This data collection will allow the CDC to determine the training and technical assistance (TA) needs of health departments and community-based organizations funded by CDC to conduct HIV prevention and surveillance activities. The intention of the data collection is to provide the training and TA in a timely and efficient manner by having them submit their needs all at once rather than individually for each training and TA need.

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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 50126	09/07/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 8250	02/14/2022
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Community-Based Organizations Needs Assessment	0920-	Community Based Organizations Needs Assessment
Health Department Needs Assessment	0920-	Health Departments Needs Assessment

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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)	66	0	0	66	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: New collection (Request for a new OMB Control Number)

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Annual Cost to Federal Government: $525,813

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.     Yes

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.     Yes

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: 02/17/2022

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