Evaluation of Core Components of the Federal Healthy Start Program

Forms and Documents

Document Name	Status
Form 001_Healthy Start Healthy Start Survey Form and Instruction	New
Response to OMB Questions Draft-4.29.11.doc Supplementary Document	2011-04-29
HS Supporting Statement_Revision_ April 2011_04 28 11.doc Supporting Statement B	2011-04-29
Attachment C. Advance Email Notification V2.pdf Supplementary Document	2010-11-14
Attachment B. Healthy Start Program Goals and Outcomes.pdf Supplementary Document	2010-11-14
Attachment A_Healthy Start Reauthorization Act of 2007.pdf Supplementary Document	2010-11-14
HS Supporting Statement_Revision_ April 2011_04 28 11.doc Supporting Statement A	2011-04-29

IC Document Collections

IC ID	Document Title	Status
195559	Healthy Start Survey Form and Instruction	New

ICR Details

OMB Control No: 0915-0338	ICR Reference No: 201012-0915-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Evaluation of Core Components of the Federal Healthy Start Program
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: 05/16/2011
	Date Received in OIRA: 12/02/2010
Terms of Clearance: This collection is approved with the understanding that this evaluation can provide information about how grantees are implementing the Healthy Start Program and about the outcomes experienced by program participants, but not establish association or a causal link between implementation strategies and outcomes. These limitations should be explained whenever the results are shared, reported, or published.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2014	36 Months From Approved
Responses	102	0	0
Time Burden (Hours)	408	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This is a one-time survey of Healthy Start Program staff. The data collection is designed to obtain information that will be used to assess program activities and services from the systems perspective. The overall purpose is to determine factors related to the successful implementation of the program, as well as the impact of Healthy Start in achieving key outcomes for participating women and children.

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Authorizing Statute(s): PL: Pub.L. 101 - 239 501 Name of Law: Maternal and Child Health Services Block Grant
   PL: Pub.L. 110 - 339 122 Name of Law: Healthy Start Reauthorization
   US Code: 42 USC 201 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:
	75 FR 22595	04/29/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 63188	10/14/2010
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
Healthy Start Survey	001_Healthy Start Survey_2010	Healthy Start Survey_2010

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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	102	0	0	0	102	0
Annual Time Burden (Hours)	408	0	0	0	408	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $529,786

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]? 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? 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: 12/02/2010

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