[NCHHSTP] Evaluation of Safe Spaces in CDC-directly funded Community-based Organizations (CBOs)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920- Staff Interviews	Form and Instruction	New	Available
Form 0920- Staff Interview	Form and Instruction	New	Repair queued
Form 0920- Client Survey	Form	New	Available
Form 0920- Client Survey (Participant)	Form	New	Repair queued
Form 0920 Eligibility Screener	Form and Instruction	New	Available
Form 0920 Eligibility Screener	Form and Instruction	New	Repair queued
Privacy Act Checklist.docx	Supplementary Document	Uploaded 2023-01-06	Repair queued
Att 1_Section 301 of the Public Health Service Act.docx	Supplementary Document	Uploaded 2023-01-06	Repair queued
SS B_121922.docx	Supporting Statement B	Uploaded 2023-01-06	Repair queued
SS A_121922.docx	Supporting Statement A	Uploaded 2023-01-06	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
257787	Staff Interview	Form and Instruction	New	Staff Interviews
257787	Staff Interview	Form and Instruction	New
257786	Client Survey (Participant)	Form	New	Client Survey
257786	Client Survey (Participant)	Form	New
257785	Eligibility Screener	Form and Instruction	New	Eligibility Screener
257785	Eligibility Screener	Form and Instruction	New

ICR Details

OMB Control No: 0920-1403	ICR Reference No: 202212-0920-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-22IJ
Title: [NCHHSTP] Evaluation of Safe Spaces in CDC-directly funded Community-based Organizations (CBOs)
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: 05/23/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/18/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2026	36 Months From Approved
Responses	2,270	0	0
Time Burden (Hours)	384	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC has required a designated safe space for clients in multiple CBO notices of funding opportunity whose intended populations are young men who have sex with men and young transgender persons of color. The purpose of this program evaluation is to understand how safe spaces currently operate, including how CBOs use safe spaces to address social determinants of health and promote HIV prevention and care.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Actr
  

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:
	87 FR 52974	09/30/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 2926	01/18/2023
Did the Agency receive public comments on this ICR? Yes

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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
Client Survey (Participant)	0920-	Client Survey
Eligibility Screener	0920	Eligibility Screener
Staff Interview	0920-	Staff Interviews

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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	2,270	0	0	2,270	0	0
Annual Time Burden (Hours)	384	0	0	384	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: $12,417

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

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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: 01/18/2023

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