Evaluation of the Cash and Counseling Demonstration

Forms and Documents

Document Name	Status
0990-0223.doc Supporting Statement B	2008-06-25
0990-0223Supporting Statment_CCv4.doc Supporting Statement A	2008-06-25

IC Document Collections

IC ID	Document Title	Status
185904	Non Participants (or Proxies) Other-survey	New
10345	Evaluation of the Cash and Counseling Demonstration	Removed

ICR Details

OMB Control No: 0990-0223	ICR Reference No: 200807-0990-002
Status: Historical Active	Previous ICR Reference No: 200204-0990-001
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Evaluation of the Cash and Counseling Demonstration
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/30/2009
	Date Received in OIRA: 07/29/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2012	36 Months From Approved
Responses	600	0	0
Time Burden (Hours)	270	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: In this submission, the Office of the Assistant Secretary for planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services seeks clearance to reinstate and make changes to a study of adult Medicaid beneficiaries in New Jersey. This reinstatement will include a survey of beneficiaries who were eligible to enroll in the state's Cash and Counseling program, Personal Preference, but did not choose to enroll in the program, in order to inform policy makers about the factors the influence program participation.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: 241 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:
	73 FR 22949	04/28/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 39311	07/09/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Evaluation of the Cash and Counseling Demonstration
Non Participants (or Proxies)

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ICR Summary 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	600	0	0	-6,750	0	7,350
Annual Time Burden (Hours)	270	0	0	-3,226	0	3,496
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: This is a new collection.

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Annual Cost to Federal Government: $499,679

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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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: 07/17/2008

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