Red Carpet Entry (RCE) Program Implementation Project

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920 RCE Report Card	Form and Instruction	New	Repair queued
Form 0920 RCE Report Card	Form and Instruction	New	Repair queued
Form 0920- Participant Recruitment Scripts & Screener Questions	Form and Instruction	New	Repair queued
Form 0920- Screener	Form and Instruction	New	Repair queued
Form 0920 Clinic Leadership Interview Guide	Form and Instruction	New	Repair queued
Form 0920 Clinic Leadership Interview Guide	Form and Instruction	New	Repair queued
Form 0920- Implementation Staff Interview Guide -- Preparation Phase	Form and Instruction	New	Repair queued
Form 0920- Staff Interview Guide – Preparation Phase	Form and Instruction	New	Repair queued
Form 0920- Implementation Saff Interview Guidance -- Implementation Phase 2, 4, 6	Form and Instruction	New	Repair queued
Form 0920- Staff Interview Guide– Implementation Phase (months 2,4,6)	Form and Instruction	New	Repair queued
Form 0920- Staff Survey -- Implementation Phase Toolkit Materials Testing (Months 1, 3, 5)	Form and Instruction	New	Repair queued
Form 0920- Staff Interview Guide – Implementation Phase (months 1,3,5)	Form and Instruction	New	Repair queued
Form 0920- Staff Survey -- Implementation Phase Strategies Assessment (Months 2, 4, 6)	Form and Instruction	New	Repair queued
Form 0920- Staf fSurvey– Implementation Phase [Months 2, 4, 6]	Form and Instruction	New	Repair queued
Form 0920- Staff Survey -- Implementation Phase (Months 1, 3, 5)	Form and Instruction	New	Repair queued
Form 0920- Staff Survey – Implementation Phase [Months 1, 3, 5]	Form and Instruction	New	Repair queued
Form 0920- Staff Survey -- Preparation Phase	Form and Instruction	New	Repair queued
Form 0920- Staff Survey – Preparation Phase	Form and Instruction	New	Repair queued
SSB.docx	Supporting Statement B	Uploaded 2022-03-28	Repair queued
SSA.docx	Supporting Statement A	Uploaded 2022-03-28	Repair queued
Att 4d HIPAA (Span).docx	Supplementary Document	Uploaded 2022-03-09	Repair queued
Att 4c HIPAA (Eng).docx	Supplementary Document	Uploaded 2022-03-09	Repair queued
Att 4b Client Inf Con (Span).docx	Supplementary Document	Uploaded 2022-03-09	Repair queued
Att 4a Client Inf Con (Eng).docx	Supplementary Document	Uploaded 2022-03-09	Repair queued
Att 9 PrivacyImpactAssessment_PIA.pdf	Supplementary Document	Uploaded 2022-03-09	Repair queued
Att 8b Readiness Worksheet.docx	Supplementary Document	Uploaded 2022-02-07	Repair queued
Att 8a Quick Guide.docx	Supplementary Document	Uploaded 2022-02-07	Repair queued
Att 8 RCE Impl Manual.docx	Supplementary Document	Uploaded 2022-02-07	Repair queued
Att 6c Staff Palm Cards.pdf	Supplementary Document	Uploaded 2022-02-07	Repair queued
Att 6a Social Media Posts.docx	Supplementary Document	Uploaded 2022-02-07	Repair queued
Att 6b Client Palm Cards.pdf	Supplementary Document	Uploaded 2022-02-07	Repair queued
Att 5 RTI IRB Decision.pdf	Supplementary Document	Uploaded 2022-02-07	Repair queued
Att 1 Auth Legislation.docx	Supplementary Document	Uploaded 2022-02-07	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
252010	RCE Report Card	Form and Instruction	New	RCE Report Card
252010	RCE Report Card	Form and Instruction	New
252009	Screener	Form and Instruction	New	Participant Recruitment Scripts & Screener Questions
252009	Screener	Form and Instruction	New
252008	Non-Labor Cost Questionnaire	Other-EXCEL	New
252006	Clinic Leadership Interview Guide	Form and Instruction	New	Clinic Leadership Interview Guide
252006	Clinic Leadership Interview Guide	Form and Instruction	New
252005	Staff Interview Guide – Preparation Phase	Form and Instruction	New	Implementation Staff Interview Guide -- Preparation Phase
252005	Staff Interview Guide – Preparation Phase	Form and Instruction	New
252004	Staff Interview Guide– Implementation Phase (months 2,4,6)	Form and Instruction	New	Implementation Saff Interview Guidance -- Implementation Phase 2, 4, 6
252004	Staff Interview Guide– Implementation Phase (months 2,4,6)	Form and Instruction	New
252002	Staff Interview Guide – Implementation Phase (months 1,3,5)	Form and Instruction	New	Staff Survey -- Implementation Phase Toolkit Materials Testing (Months 1, 3, 5)
252002	Staff Interview Guide – Implementation Phase (months 1,3,5)	Form and Instruction	New
251473	Labor Cost Questionnaire	Other-EXCEL	New
251472	Staf fSurvey– Implementation Phase [Months 2, 4, 6]	Form and Instruction	New	Staff Survey -- Implementation Phase Strategies Assessment (Months 2, 4, 6)
251472	Staf fSurvey– Implementation Phase [Months 2, 4, 6]	Form and Instruction	New
251470	Staff Survey – Implementation Phase [Months 1, 3, 5]	Form and Instruction	New	Staff Survey -- Implementation Phase (Months 1, 3, 5)
251470	Staff Survey – Implementation Phase [Months 1, 3, 5]	Form and Instruction	New
251468	Staff Survey – Preparation Phase	Form and Instruction	New	Staff Survey -- Preparation Phase
251468	Staff Survey – Preparation Phase	Form and Instruction	New

ICR Details

OMB Control No: 0920-1379	ICR Reference No: 202202-0920-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-21HI
Title: Red Carpet Entry (RCE) Program Implementation Project
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 without change	Conclusion Date: 12/02/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/29/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2024	24 Months From Approved
Responses	342	0	0
Time Burden (Hours)	127	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This project will implement the Red Carpet Entry (RCE) program (a structural level intervention developed by DC Department of Health in 2009) in two (2) clinics. An implementation toolkit will be created, used by staff to implement RCE, and evaluated by the contractor. Up to 126 clinic patients will be consented for medical record abstraction. Interview and survey data will be collected from clinic staff (n=10) on RCE implementation. The toolkit will be finalized based on the study's findings. The final toolkit will be shared with health departments to enhance HIV care linkage and re-engagement.

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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 46852	08/20/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 17295	03/28/2022
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 11

table that charts list of burden

IC Title	Form No.	Form Name
Clinic Leadership Interview Guide	0920	Clinic Leadership Interview Guide
Labor Cost Questionnaire
Non-Labor Cost Questionnaire
RCE Report Card	0920	RCE Report Card
Screener	0920-	Participant Recruitment Scripts & Screener Questions
Staf fSurvey– Implementation Phase [Months 2, 4, 6]	0920-	Staff Survey -- Implementation Phase Strategies Assessment (Months 2, 4, 6)
Staff Interview Guide – Implementation Phase (months 1,3,5)	0920-	Staff Survey -- Implementation Phase Toolkit Materials Testing (Months 1, 3, 5)
Staff Interview Guide – Preparation Phase	0920-	Implementation Staff Interview Guide -- Preparation Phase
Staff Interview Guide– Implementation Phase (months 2,4,6)	0920-	Implementation Saff Interview Guidance -- Implementation Phase 2, 4, 6
Staff Survey – Implementation Phase [Months 1, 3, 5]	0920-	Staff Survey -- Implementation Phase (Months 1, 3, 5)
Staff Survey – Preparation Phase	0920-	Staff Survey -- Preparation Phase

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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	342	0	0	342	0	0
Annual Time Burden (Hours)	127	0	0	127	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: $662,634

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.     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: 03/29/2022

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