OMB Fast Track Memo

Request for Approval under the “Voluntary Partner Surveys to Implement Executive Order 12862” (OMB Control Number: 0906-0084)

TITLE OF INFORMATION COLLECTION: 2024 HRSA/HIV & AIDS Bureau (HAB) Recipients Satisfaction Survey (RSS).

PURPOSE: Improve the Ryan White HIV/AIDS Program through feedback received from program recipients based on their experiences with HAB and our technical assistance partners over the past 12 months.

DESCRIPTION OF RESPONDENTS: Ryan White HIV/AIDS Program Recipients (RWHAP).

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ X] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software) [ ] Small Discussion Group

[ ] Focus Group [ ] Other:

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: Dorothy Menelas

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [ X ] No

2. If yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden Hours Total
RWHAP Recipients	250	14 minutes	58 hours, 20 mins
Totals	250	14	58 hours, 20 mins*

* In ROCIS 58 hours, 20 minutes converts to 58.33 in the Information Collection Burden table. This rounds down to 58 hours.

FEDERAL COST:

The estimated annual cost to the federal government is $37,400.00, which includes an IAA with Department of Interior for work to be done by contractor named Federal Consulting Group.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [X] Yes [ ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

We will be using HAB’s Ryan White Program Recipient listserv.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [X] No

Please make sure that all instruments, instructions, and scripts are submitted with the request.

• Final Survey Document