Ryan White HIV/AIDS Program Expenditure Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Part B Supplemental Expenditures Report	Form and Instruction	New	Available
Form 5 EHE Expenditures Reports	Form	Modified	Available
Form 4 Part D Expenditure Report	Form	Modified	Available
Form 3 Part C Expenditure Report	Form	Modified	Available
Form 2 Part B Expenditures Report and Changes Summary	Form	Modified	Available
Form 1 Part A Expenditures Report and Changes Summary	Form	Modified	Available
0915-0390_Comment 1_Guzman_03.02.2026.pdf	Public Comments	Uploaded 2026-03-02	Available
0915-0390_Comment 1 Transmittal_Guzman_03.02.2026.pdf	Public Comments	Uploaded 2026-03-02	Available
Supporting Statement- 0915-0390 - HAB - RWHAP Expenditures Report Forms Final 4.23.26.docx	Supporting Statement A	Uploaded 2026-04-29	Available
Attachment A - legislation-title-xxvi.pdf	Supplementary Document	Uploaded 2023-05-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
280138	Part B Supplemental Expenditures Report	Form and Instruction	New	Part B Supplemental Expenditures Report
260461	EHE Expenditures Reports	Form	Modified	EHE Expenditures Reports
260460	Part D Expenditure Report	Form	Modified	Part D Expenditure Report
260459	Part C Expenditure Report	Form	Modified	Part C Expenditure Report
260458	Part B Expenditures Report	Form	Modified	Part B Expenditures Report and Changes Summary
260457	Part A Expenditures Report	Form	Modified	Part A Expenditures Report and Changes Summary

ICR Details

OMB Control No: 0915-0390	ICR Reference No: 202604-0915-004
Status: Received in OIRA	Previous ICR Reference No: 202308-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Ryan White HIV/AIDS Program Expenditure Forms
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 04/30/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	07/31/2026
Responses	648	615
Time Burden (Hours)	2,530	2,568
Cost Burden (Dollars)	0	0

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Abstract: HRSA administers the Ryan White HIV/AIDS Program (RWHAP) authorized under Title XXVI of the Public Health Service Act. The RWHAP Allocations and Expenditures Reports (A&E Reports) allow HRSA to monitor and track the use of grant funds for compliance with program and grants policies, and requirements as outlined in the legislation. Recipients funded under RWHAP Parts A, B, C, and D are required to report financial data to HRSA at the beginning (Allocations Report) and at the end (Expenditures Report) of their grant budget period. The A&E Reports request information recipients already collect, including the use of RWHAP grant funds for core medical and support services; and on various program components, such as administration, planning and evaluation, and clinical quality management. RWHAP Parts A and B recipients funded under the Ending the HIV Epidemic in the U.S. (EHE) initiative are also required to report allocations and expenditures of the grant budget period in the EHE A&E Reports. This allows HRSA to track and report progress toward meeting the EHE goals. The reports are similar in content; however, in the first report, recipients document the allocation of their RWHAP or EHE grant award at the beginning of their grant budget period. In the second report, recipients document actual expenditures of their RWHAP or EHE grant award (including any carryover dollars) at the end of their grant budget period. This package only includes the Expenditures Report. The Allocations Report is 0915-0318

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Authorizing Statute(s): US Code: 42 USC 300ff-11 Name of Law: Public Health Service Act
  

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:
	90 FR 61403	12/31/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 23108	04/29/2026
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
EHE Expenditures Reports	5	EHE Expenditures Reports
Part A Expenditures Report	1	Part A Expenditures Report and Changes Summary
Part B Expenditures Report	2	Part B Expenditures Report and Changes Summary
Part B Supplemental Expenditures Report	1	Part B Supplemental Expenditures Report
Part C Expenditure Report	3	Part C Expenditure Report
Part D Expenditure Report	4	Part D Expenditure Report

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	648	615	0	33	0	0
Annual Time Burden (Hours)	2,530	2,568	0	-38	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There are no proposed changes to any of the forms. However, there is a small decrease of 38 burden hours compared to the currently approved collection, due to RWHAP recipients’ familiarity with the updated reporting requirements introduced in the currently approved collection. The "new" form is actually the Part B Supplemental Expenditures Report that was included in the same IC as the Part B expenditures report. We've added them as separate reports to make sure we reflect what is in the Supporting Statement.

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Annual Cost to Federal Government: $151,796

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: 04/30/2026

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