OMB control number

Performance Monitoring of “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations

OMB 0920-1156 · HHS/CDC.

OMB 0920-1156

The goal of the study is to evaluate and improve efforts of three awardees funded to work with health centers to enhance implementation of best practices in adolescent reproductive health care. Information collected will be used to continue monitoring awardee performance and determine training and technical assistance. Awardees will continue to conduct assessments of health center organizations, surveys of providers at the health center partner organizations, as well as report on their own activities. This is a request for a Revision of a currently approved data collection (Exp. 1/31/2020) to continue data collection for health center partners and awardees until the end of the funding period (9/30/2020).

The latest form for Performance Monitoring of “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations expires 2021-04-30 and is listed under ICR 201912-0920-012.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Youth Serving Organization (YSO) Staff Survey	Form and Instruction
Youth Serving Organization (YSO) Performance Measure Reporting Tool	Form
Youth Serving Organization (YSO) Organizational Assessment	Form
Form 0920-1156 Health Center Provider Survey	Form and Instruction
Form 0920-1156 Annual Health Center Performance Measure Reporting Tool	Form and Instruction
Form 0920-1156 Quarterly Health Center Perfoemance Measure Reporting Tool	Form and Instruction
Form 0920-1156 Health Center Organizational Assessment	Form and Instruction
Health Center Youth Survey	Form and Instruction
Form 0920-1156 Awardee Performance Measure Reporting Tool	Form and Instruction
Form 0920-1156 Awardee Training and Techmnical Assistance Tool	Form and Instruction
Youth Serving Organization (YSO) Staff Survey	Form and Instruction
Youth Serving Organization (YSO) Performance Measure Reporting Tool	Form and Instruction
Youth Serving Organization (YSO) Organizational Assessment	Form and Instruction
Form 0920-1156 Health Center Provider Survey	Form and Instruction
Form 0920-1156 Annual Health Center Performance Measure Reporting Tool	Form and Instruction
Form 0920-1156 Quarterly Health Center Performance Measure Reporting Tool	Form and Instruction
Form 0920-1156 Health Center Organizational Assessment	Form and Instruction
Research Determination Teen Preg Final.pdf	Supplementary Document
Att 10a 60 day Federal Register Notice.pdf	Supplementary Document
Att 9 logic model.docx	Supplementary Document
Att 2 Crosswalk of Objectives and Data Sources_080219.docx	Supplementary Document
Att 1-Authorizing Legislation.pdf	Supplementary Document
SSB Working with Public Centers Teen Preg ICRO Final.docx	Supporting Statement B
SSA Working with Public Centers Teen Preg ICRO Final.docx	Supporting Statement A
Youth Serving Organization (YSO) Staff Survey	Form and Instruction
Youth Serving Organization (YSO) Performance Measure Reporting Tool	Form
Youth Serving Organization (YSO) Organizational Assessment	Form
Health Center Provider Survey	Form and Instruction
Annual Health Center Performance Measure Reporting Tool	Form and Instruction
Quarterly Health Center Perfoemance Measure Reporting Tool	Form and Instruction
Health Center Organizational Assessment	Form and Instruction
Health Center Youth Survey	Form and Instruction
Awardee Performance Measure Reporting Tool	Form and Instruction
Awardee Training and Techmnical Assistance Tool	Form and Instruction
Youth Serving Organization (YSO) Staff Survey	Form and Instruction
Youth Serving Organization (YSO) Performance Measure Reporting Tool	Form and Instruction
Youth Serving Organization (YSO) Organizational Assessment	Form and Instruction
Health Center Provider Survey	Form and Instruction
Annual Health Center Performance Measure Reporting Tool	Form and Instruction
Quarterly Health Center Performance Measure Reporting Tool	Form and Instruction
Health Center Organizational Assessment	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
201912-0920-012	Revision of a currently approved collection	2020-01-27	Approved without change
201703-0920-010	No material or nonsubstantive change to a currently approved collection	2017-03-22	Approved without change
201607-0920-001	New collection (Request for a new OMB Control Number)	2016-07-13	Approved without change

OMB Details

Health Center Organizational Assessment

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
Form	Name	Electronic access	Type
Form 0920-1156	Health Center Org Assessment	Fillable Fileable	Form and instruction
Form 0920-1156	Health Center Org Assessment Online	Fillable Fileable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.