OMH Minority Leadership Development Program Post-Program Questionnaire

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0990-0379 MEMO_FastTrack Generic Clearance Submission Template_MLDP_060723.docx	Supporting Statement A	Uploaded 2023-06-27	Available
0990-0379 MEMO_FastTrack Generic Clearance Submission Template_MLDP_060723.docx	Supporting Statement A	Uploaded 2023-06-27	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
260857	OMH Minority Leadership Development Program Post-Program Questionnaires	Other-Questionnaire	New

ICR Details

OMB Control No:	ICR Reference No: 202306-0990-014
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: OMH Minority Leadership Development Program Post-Program Questionnaire
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 07/27/2023
OIRA Conclusion Action: Improperly submitted	Conclusion Date: 07/28/2023
	Date Received in OIRA: 07/14/2023
Terms of Clearance: As discussed with HHS PRA Clearance Officer Sherrette Funn, this ICR was improperly submitted as a new emergency request when it should be a fast-track generic under OMB Control No. 0990-0379.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		09/30/2023
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Minority Leadership Development Program (MLDP) seeks to fill a gap in federal and non-federal opportunities for individuals interested in public health and health equity and federal leadership positions. The OMH-supported MLDP fellowship includes fellows, OMH grant recipients, and HHS host sites. Therefore, collecting survey data is vital to providing insight into the current program and impacting future fellowship program development. In addition, the information captured in the surveys will measure post-program data vital to the evaluation of the program.

Emergency Justfication: Contractor's period of work, including this activity, ends 9/29/23.

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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

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
OMH Minority Leadership Development Program Post-Program Questionnaires

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Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government:

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: 07/14/2023

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