Annual Performance Report for the State Grant for Assistive Technology Program

Forms and Documents

Document Name	Status
Statewide AT Annual Performance Measurements Report Form	Modified
Statewide AT Customer Satisfaction Survey Form and Instruction	Modified
Form OMB Control 1820-0 Annual Report for the State Grant for Assistive Technology Program Form	Modified
RSA Response to 60Day 1820-0572.docx Supplementary Document	2014-08-28
Control 14-003232-SGAT 572 IC Supporting Statement 8-28-14.docx Supporting Statement A	2014-08-28
60D_FRN_1820-0572.pdf Supplementary Document	2014-07-25
Control 14-003232-572 Report Revisions by Page Number 2014.docx Supplementary Document	2014-07-25

IC Document Collections

IC ID	Document Title	Status
46672	Statewide AT Annual Performance Measurements Report Form	Modified
46671	Statewide AT Customer Satisfaction Survey Form and Instruction	Modified
21562	Annual Report for the State Grant for Assistive Technology Program Form	Modified

ICR Details

OMB Control No: 0985-0042	ICR Reference No: 201505-0985-002
Status: Historical Active	Previous ICR Reference No: 201107-1820-001
Agency/Subagency: HHS/ACL	Agency Tracking No: 1140.19
Title: Annual Performance Report for the State Grant for Assistive Technology Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/18/2015
	Date Received in OIRA: 05/18/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	36 Months From Approved
Responses	190,456	0	190,456
Time Burden (Hours)	23,772	0	23,996
Cost Burden (Dollars)	0	0	0

---

Abstract: Section 4 of the Assistive Technology (AT) Act of 1998, as amended, requires states to submit annual data reports. This instrument helps the grantees report annual data related to the required activities implemented by the State under the AT Act. This data is used by Rehabilitation Services Administration (RSA) in order to prepare required annual reports to Congress. RSA calls this data collection an Annual Progress Report.

---

Authorizing Statute(s): PL: Pub.L. 108 - 364 4 Name of Law: Assistive Technology Act of 1998, as amended
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 36029	06/25/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 53698	09/10/2014
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Annual Report for the State Grant for Assistive Technology Program	OMB Control 1820-0572	Annual Performance Report
Statewide AT Customer Satisfaction Survey	NA	SGAT Customer Survey
Statewide AT Annual Performance Measurements Report	N/A	State Assessment and Performance Measurement Form

---

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	190,456	190,456	0	0	0	0
Annual Time Burden (Hours)	23,772	23,996	0	-224	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There is a program change decrease of -224 hours. This information collection includes a decrease of 4 burden hours from 406 hours to 402 hours per state AT program for a total reduction burden of 224 hours. The burden hour decrease is a result of a reduction due to the updates to the instrument. The proposed State Grant for AT IC package will result in a reduction in burden, but not a reduction in the number of respondents.

---

Annual Cost to Federal Government: $264,390

Does this IC contain surveys, censuses, or employ statistical methods? No

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

---

Common Form ICR:  No

---

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: 09/10/2014

---