OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Community-based Organization (CBO) Monitoring and Evaluation Project (CMEP) of WILLOW (CMEP-WILLOW)

ICR 201406-0920-006 · OMB 0920-0896 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
180-day Follow-up Survey Form Modified Available
90-day Follow-up Interview Form Modified Available
Form 3 Baseline Survey Form and Instruction Removed Available
Form 1 Eligibility Screener Form and Instruction Removed Available
att1_PHSAsect301.pdf Supplementary Document Uploaded 2014-06-05 Available
60-Day FRN.pdf Supplementary Document Uploaded 2014-06-05 Repair queued
Attachment 2A_Nonsubstantive Public Comments.docx Supplementary Document Uploaded 2014-06-05 Available
SS-Part B.doc Supporting Statement B Uploaded 2014-06-05 Available
SS-Part A WILLOW rev aug 26.doc Supporting Statement A Uploaded 2014-08-28 Available
IC Document Collections
IC IDCollectionTypeStatusForm
198815 180-day Follow-up Interview--Grantee Instruction Modified
198814 180-day Follow-up Survey Form Modified
198813 90-day Follow-up Interview--Grantees Instruction Modified
198812 90-day Follow-up Interview Form Modified
198811 Baseline Survey--Grantees Other-Screen shot Removed
198810 Baseline Survey Form and Instruction Removed
198809 Eligibility Screener--Grantees Other-screen shot Removed
198808 Eligibility Screener Form and Instruction Removed
ICR Details
0920-0896 201406-0920-006
Historical Active 201108-0920-002
HHS/CDC
Community-based Organization (CBO) Monitoring and Evaluation Project (CMEP) of WILLOW (CMEP-WILLOW)
Extension without change of a currently approved collection   No
Regular
Approved with change 08/29/2014
Retrieve Notice of Action (NOA) 06/18/2014
This extension allows each site to continue using only the incentive levels that they already used for 90- and 180-day follow ups in their area. This approval should not be interpreted as a precedent for differential incentives.
  Inventory as of this Action Requested Previously Approved
08/31/2015 12 Months From Approved 08/31/2014
736 0 1,732
200 0 358
0 0 0
The Community-based Organization Monitoring and Evaluation Project of WILLOW serves to monitor changes in client's self-reported HIV risk behaviors and attitudes after participating in the Effective Behavioral Intervention (EBI) WILLOW as delivered by CDC-funded CBOs and to assess the fidelity of the delivery of WILLOW at CBOs. From October 2011 throuigh March 21, 2014, baseline surveys were conducted with 941 participants; 90 day follow up surveys were completed with 700 participants,and 180 day follow up surveys with 609 participants. We request an additional year of approval to complete follow up surveys for participants completing the intervention before 8/31/2014.
US Code: 42 USC 241 Name of Law: PHSA
  
None
Not associated with rulemaking
  79 FR 13653 03/11/2014
79 FR 33194 06/10/2014
Yes
  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 736 1,732 0 -996 0 0
Annual Time Burden (Hours) 200 358 0 -158 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
The reduction in burden is due to this extension request only including the remaining follow up surveys for the last group of participants to receive the intervention and the last data submissions from the grantees to CDC. The screeners and baseline surveys have been removed.
$755,325
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Shari Steinberg 404 639-4942 [email protected]
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/18/2014