Evaluation of Programs Supporting the Mental Health of the Health Professions Workforce

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Healthcare Workforce Survey	Form and Instruction	New	Repair queued
Form 4 Awardee Training and Services Report	Form and Instruction	New	Available
Form 4 Awardee Training and Services Report	Form and Instruction	New	Repair queued
Form 3 The Workforce Program Awardee Cost Workbook	Form and Instruction	New	Available
Form 3 The Workforce Program Awardee Cost Workbook	Form and Instruction	New	Repair queued
Form 3 The Training Program Awardee Cost Workbook	Form and Instruction	New	Available
Form 3 The Training Program Awardee Cost Workbook	Form and Instruction	New	Repair queued
Form 2 Awardee Survey about the Technical Assistance Center	Form and Instruction	New	Available
Form 2 Awardee Survey about the Technical Assistance Center	Form and Instruction	New	Repair queued
Form 1A Fielding Tracker	Form and Instruction	New	Available
Form 1A The Healthcare Workforce Fielding Tracker	Form and Instruction	New	Repair queued
Form 1 Healthcare Workforce Screener and Survey_6.5.23_clean	Form and Instruction	New	Available
Form 1 The Training Program Comparison Group Survey	Form and Instruction	New	Repair queued
Form 1 Healthcare Workforce Screener and Survey_6.5.23_clean	Form and Instruction	New	Available
Form 1 The Training Program Comparison Group Screener	Form and Instruction	New	Repair queued
Form 1 Healthcare Workforce Survey	Form and Instruction	New	Available
6(A-B). The Workforce Program Org Assessment Interview Guide Respondent Contact Materials_6.5.23.docx	Supplementary Document	Uploaded 2023-09-08	Repair queued
5(A-B). The Training Program Awardee Interview Invite and Reminders_6.5.23.docx	Supplementary Document	Uploaded 2023-09-08	Repair queued
4(A-C). Awardee Training and Services Report Respondent Contact Materials_6.5.23.docx	Supplementary Document	Uploaded 2023-09-08	Repair queued
3(A-D). Cost-Benefit Workbook Respondent Contact Materials_6.5.23.docx	Supplementary Document	Uploaded 2023-09-08	Repair queued
2(A-H). Awardee Survey about TAC Respondent Contact Materials_6.5.23.docx	Supplementary Document	Uploaded 2023-09-08	Repair queued
1(K-P). The Training Program Comparison Group Survey Respondent Contact Materials_6.5.23.docx	Supplementary Document	Uploaded 2023-09-08	Repair queued
1(B-J). Healthcare Workforce Survey Respondent Contact Materials_6.5.23.docx	Supplementary Document	Uploaded 2023-09-08	Repair queued
Evaluation of Programs Supporting MH of HPW - Supporting Statement A - Final - Revised.docx	Supporting Statement A	Uploaded 2023-09-08	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
264049	Healthcare Workforce Survey	Form and Instruction	New	Healthcare Workforce Survey
262100	The Workforce Program Organizational Assessment Interview Protocol	Other-Virtual Interview Guide	New
262099	The Training Program Awardee Interview Guide	Other-Virtual Interview Guide	New
262098	Awardee Training and Services Report	Form and Instruction	New	Awardee Training and Services Report
262098	Awardee Training and Services Report	Form and Instruction	New
262097	The Workforce Program Awardee Cost Workbook	Form and Instruction	New	The Workforce Program Awardee Cost Workbook
262097	The Workforce Program Awardee Cost Workbook	Form and Instruction	New
262096	The Training Program Awardee Cost Workbook	Form and Instruction	New	The Training Program Awardee Cost Workbook
262096	The Training Program Awardee Cost Workbook	Form and Instruction	New
262095	Awardee Survey about the Technical Assistance Center	Form and Instruction	New	Awardee Survey about the Technical Assistance Center
262095	Awardee Survey about the Technical Assistance Center	Form and Instruction	New
262094	The Healthcare Workforce Fielding Tracker	Form and Instruction	New	Fielding Tracker
262094	The Healthcare Workforce Fielding Tracker	Form and Instruction	New
262092	The Training Program Comparison Group Survey	Form and Instruction	New	Healthcare Workforce Screener and Survey_6.5.23_clean
262092	The Training Program Comparison Group Survey	Form and Instruction	New
262091	The Training Program Comparison Group Screener	Form and Instruction	New	Healthcare Workforce Screener and Survey_6.5.23_clean
262091	The Training Program Comparison Group Screener	Form and Instruction	New
262090	Healthcare Workforce Survey	Form and Instruction	New

ICR Details

OMB Control No: 0915-0396	ICR Reference No: 202309-0915-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Evaluation of Programs Supporting the Mental Health of the Health Professions Workforce
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: 01/02/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/12/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2027	36 Months From Approved
Responses	212,229	0	0
Time Burden (Hours)	17,426	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the planned evaluation is to assess the Training Program, the Workforce Program, and the Technical Assistance Center program with respect to their goals of promoting resiliency and mental health in the health workforce. Data collection efforts will inform HRSA leadership about the progress, costs and benefits, and impact of these efforts to support the delivery of health care in the United States.

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Authorizing Statute(s): PL: Pub.L. 117 - 2 2703 Name of Law: American Rescue Plan Act of 2021
  

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:
	88 FR 29137	05/05/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 47511	07/24/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 10

table that charts list of burden

IC Title	Form No.	Form Name
Awardee Survey about the Technical Assistance Center	2	Awardee Survey about the Technical Assistance Center
Awardee Training and Services Report	4	Awardee Training and Services Report
Healthcare Workforce Survey	1	Healthcare Workforce Survey
The Healthcare Workforce Fielding Tracker	1A	Fielding Tracker
The Training Program Awardee Cost Workbook	3	The Training Program Awardee Cost Workbook
The Training Program Awardee Interview Guide
The Training Program Comparison Group Screener	1	Healthcare Workforce Screener and Survey_6.5.23_clean
The Training Program Comparison Group Survey	1	Healthcare Workforce Screener and Survey_6.5.23_clean
The Workforce Program Awardee Cost Workbook	3	The Workforce Program Awardee Cost Workbook
The Workforce Program Organizational Assessment Interview Protocol

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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	212,229	0	0	212,229	0	0
Annual Time Burden (Hours)	17,426	0	0	17,426	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: This is a new data collection.

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Annual Cost to Federal Government: $1,837,192

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: 09/12/2023

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