DoNation General Workplace Campaign Scorecard

Forms and Documents

Document Name	Status
Form 1 DoNation General Workplace Campaign Scorecard Form	New
07152022 - OMB DoNation Campaign Supporting Statement - CLEAN.docx Supporting Statement A	2022-07-26

IC Document Collections

IC ID	Document Title	Status
254850	DoNation General Workplace Campaign Scorecard Form	New

ICR Details

OMB Control No:	ICR Reference No: 202207-0906-002
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: DoNation General Workplace Campaign Scorecard
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/19/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	1,400	0
Time Burden (Hours)	350	0
Cost Burden (Dollars)	0	0

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Abstract: The Health Resources and Services Administration (HRSA), Health Systems Bureau, Division of Transplantation (DoT) administers the Hospital Campaign for Organ Donation under the authority of Section 377A(a) of the Public Health Service (PHS) Act. As part of its responsibility to conduct public education and outreach to increase the number of registered organ donors, HRSA launched the Workplace Partnership for Life Hospital Campaign in 2011, with a challenge to hospitals nationwide to conduct donor education and donor registry enrollment events in their facilities and communities. The purpose of the ‘DoNation’ General Workplace Campaign is to encourage other non-medical U.S. companies to conduct activities to increase organ donor registration. These workplaces’ support of organ donation is vital to HRSA’s efforts to increase donor registrations, as expanding the program outside of medical settings will broaden the pool of potential registered organ, eye, and tissue donors. The overall purpose of collecting this information is to incentivize and reward company, workplace, and Organ Procurement Organization (OPO) participation in the campaign, and to enable HRSA to obtain outcome data. Because participating in this campaign is voluntary, it is essential for HRSA to implement a methodology to engage workplaces, make participation as easy as possible, and recognize workplaces for their efforts and accomplishments. HRSA, together with its donation community partners, developed the Activity Scorecard for the Hospital Campaign that provides suggested outreach activities for hospitals to implement and a way to gather points for achieving recognition. The ‘DoNation’ General Workplace Campaign Activity Scorecard will motivate workplaces in a similar fashion. Without the Activity Scorecard, HRSA would not be able to recognize workplaces for their extra efforts in planning donor registration activities and registering new organ, eye, and tissue donors.

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Authorizing Statute(s): PL: Pub.L. 177 - 159 377(a) 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:
	86 FR 50138	09/07/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 48186	08/08/2022
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
DoNation General Workplace Campaign Scorecard	1	OMB DoNation Scorecard

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ICR Summary of Burden

	Total Request	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	1,400	0	0	1,400	0	0
Annual Time Burden (Hours)	350	0	0	350	0	0
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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $24,310

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.     No

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]? 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? No

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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: 08/19/2022

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