National and Tribal Evaluation of the 2nd Generation of the Health Profession Opportunity Grants

Forms and Documents

Document Name	Status
DRAFT HPOG 2.0 Memo to OMB_Post-Training Changes to Instrument 12_09272018.docx Justification for No Material/Nonsubstantive Change	2018-09-28
DRAFT HPOG 2.0 Memo to OMB_Pretest Changes _Expanded Site Visits_V4_091118_CLEAN.docx Justification for No Material/Nonsubstantive Change	2018-09-11
DRAFT HPOG 2.0 Memo to OMB_Pretest Changes _Expanded Site Visits_V4_091118_CLEAN.docx Justification for No Material/Nonsubstantive Change	2018-09-11
Attachment O_ResearchQuestions for Previously Approved National and Tribal Evaluation Efforts.docx Supplementary Document	2018-02-01
Attachment N_HPOG2.0_Short-Term Followup Short-Term Survey_ Email Remind_revised_010918_clean.docx Supplementary Document	2018-02-01
Attachment M_HPOG 2.0_Short-Term Survey Flyer 01092018.docx Supplementary Document	2018-02-01
Attachment L_HPOG 2.0 Short-Term Followup Followup Survey Sources_Rev_121217_Clean.docx Supplementary Document	2018-02-01
Attachment K_HPOG2.0_Short-Term Followup Survey Advance Letter_Rev_01092018_Clean.docx Supplementary Document	2018-02-01
Memo to OMB RE_Contact Update Form_05302017_Revised_07-11-17_CLEAN.DOCX Justification for No Material/Nonsubstantive Change	2017-07-12
Attachment K_HPOG 2 0 Incentive Communications_Email and Letter_071117 CLEAN.docx Supplementary Document	2017-07-12
Attachment J_Interview Verbal Informed Consent Form.docx Supplementary Document	2016-10-24
Attachment I_Focus Group Informed Consent Form.doc Supplementary Document	2016-10-24
Attachment H_HPOG- Model.pptx Supplementary Document	2016-10-24
Attachment B3_Tribal Evaluation Informed Consent Form B (Unique Identifiers).docx Supplementary Document	2016-06-16
Attachment B2_Tribal Evaluation Informed Consent Form A (SSNs).docx Supplementary Document	2016-06-16
Attachment B_Approved non-tribal, adult lottery not required consent form.docx Supplementary Document	2016-06-16
HPOG2 Supporting Statement_Updated Part A_June 2016 - TRACK CHANGES.docx Supplementary Document	2016-06-16
Memo to OMB RE_Revised Consent Forms for Tribal Study_06 15 16.docx Justification for No Material/Nonsubstantive Change	2016-06-16
Memo to OMB RE_Revised Consent Forms 011116_v3.docx Justification for No Material/Nonsubstantive Change	2016-01-26
Attachment A_References_Revised 09 02 16.docx Supplementary Document	2016-10-24
Attachment G. Contact Update Letter and Form.docx Supplementary Document	2015-05-11
HPOG 2.0_Supporting Statement_Part B_091118_CLEAN.docx Supporting Statement B	2018-09-11
HPOG 2.0_Supporting Statement Part A_REV_091218_clean.docx Supporting Statement A	2018-09-13
Attachment F. First Round of HPOG Grantees Ressearch Portfolio_4.28.15.docx Supplementary Document	2015-05-06
FINAL updated Attachment E PPR Data List and Mockup 8 4 15 clean.docx Supplementary Document	2015-08-05
Attachment D. Sources and Justification_5.4.15.docx Supplementary Document	2015-05-06
Attachment C_HPOG 2.0 15 mos follow up - 60 Day FRN_8.30.17.pdf Supplementary Document	2018-02-01
Attachment B. Informed Consent Forms_01.25.16 clean.docx Supplementary Document	2016-01-26

IC Document Collections

IC ID	Document Title	Status
229940	Instrument 12: Short-Term Follow-up Survey for the HPOG 2.0 National Evaluation Impact Evaluation Other-Survey	Modified
229938	*NOT NEW* Instrument 5b: HPOG 2.0 National Evaluation letter and participant contact update form Other-Update Form	Unchanged
224119	Instrument 11: HPOG 2.0 Tribal Evaluation program participant non-completer interviews Other-Interview	Unchanged
224118	Instrument 10: HPOG 2.0 Tribal Evaluation program participant completer interviews Other-Interview	Unchanged
224113	Instrument 9: HPOG 2.0 Tribal Evaluation program participant focus groups Other-Focus Group	Unchanged
224112	Instrument 8: HPOG 2.0 Tribal Evaluation employer interviews Other-Interview	Unchanged
224110	Instrument 7: HPOG 2.0 Tribal Evaluation program implementation staff interviews Other-Interview	Unchanged
224107	Instrument 6: HPOG 2.0 Tribal Evaluation grantee and partner administrative staff interviews Other-Interview	Unchanged
224101	Instrument 5a: HPOG 2.0 National Evaluation welcome packet, letter and participant contact update forms Other-Welcome Packet	Unchanged
224098	Instrument 4: HPOG 2.0 National Evaluation in-person implementation interviews Other-Interview	Unchanged
216432	PAGES Participant-Level Baseline Data Collection (participants at Tribal grantees) Other-Data collection System	Unchanged
216431	PAGES Participant-Level Baseline Data Collection (participants at non-Tribal grantees participating in impact study) Other-Data collection System	Unchanged
216430	PAGES Grantee- and Participant-Level Data Collection (all grantees) Other-Data collection System	Unchanged

ICR Details

OMB Control No: 0970-0462	ICR Reference No: 201809-0970-007
Status: Historical Active	Previous ICR Reference No: 201808-0970-004
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: National and Tribal Evaluation of the 2nd Generation of the Health Profession Opportunity Grants
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/26/2018
	Date Received in OIRA: 09/28/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2021	06/30/2021	06/30/2021
Responses	31,300	0	31,300
Time Burden (Hours)	11,044	0	11,044
Cost Burden (Dollars)	0	0	0

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Abstract: The ACF Office of Planning, Research and Evaluation (OPRE) has developed a multi-pronged research and evaluation portfolio for the HPOG 2.0 Program to better understand and assess the activities conducted and their results. This submission is in support of two components of the evaluation portfolio, the HPOG 2.0 National Evaluation and HPOG 2.0 Tribal Evaluation. OMB has previously approved several information collection requests under OMB Control Number 0970-0462 in support of both the National and Tribal evaluations. Under this information collect request, ACF seeks approval for the National Evaluation impact study’s Short-Term Follow-up Survey, to be conducted 15 months after randomization. This request is for a non-substantive change. This submission seeks approval for three nonsubstantive changes to previously approved information collection requests. First, it requests approval for minor changes in content to the National Evaluation impact study’s Short-Term Follow-up Survey (Instrument #12, approved in June 2018). Second, it seeks approval to add one additional question to Instrument #12. Third, it seeks approval for a modest increase in burden for the previously approved in-person implementation interviews (Instrument #4, approved in June 2017). Justification for these non-substantive changes can be found in the supplementary document HPOG 2.0 Memo to OMB_Pretest changes_Expanded Site Visits_V4_REV091118.docx.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 5507 , sec. 2008, (a)(3)(B) Name of Law: Patient Protection and Affordable Care 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:
	82 FR 41269	08/30/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 5104	02/05/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 13

IC Title	Form No.	Form Name
Instrument 5a: HPOG 2.0 National Evaluation welcome packet, letter and participant contact update forms
Instrument 9: HPOG 2.0 Tribal Evaluation program participant focus groups
Instrument 6: HPOG 2.0 Tribal Evaluation grantee and partner administrative staff interviews
Instrument 7: HPOG 2.0 Tribal Evaluation program implementation staff interviews
Instrument 8: HPOG 2.0 Tribal Evaluation employer interviews
Instrument 10: HPOG 2.0 Tribal Evaluation program participant completer interviews
Instrument 11: HPOG 2.0 Tribal Evaluation program participant non-completer interviews
PAGES Participant-Level Baseline Data Collection (participants at non-Tribal grantees participating in impact study)
PAGES Grantee- and Participant-Level Data Collection (all grantees)
PAGES Participant-Level Baseline Data Collection (participants at Tribal grantees)
Instrument 4: HPOG 2.0 National Evaluation in-person implementation interviews
*NOT NEW* Instrument 5b: HPOG 2.0 National Evaluation letter and participant contact update form
Instrument 12: Short-Term Follow-up Survey for the HPOG 2.0 National Evaluation Impact Evaluation

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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	31,300	31,300	0	0	0	0
Annual Time Burden (Hours)	11,044	11,044	0	0	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $4,910,849

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.     Yes

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]? Yes

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: 09/28/2018

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