OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Integrating Community Pharmacists and Clinical Sites for Patient-Centered HIV Care

ICR 201406-0920-009 · OMB 0920-1019 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Att 9b_Information Form_Spanish.docx Supplementary Document Uploaded 2014-06-16 Repair queued
Att 9a_Information Form_English.docx Supplementary Document Uploaded 2014-06-16 Repair queued
Change request for 0920-1019.docx Justification for No Material/Nonsubstantive Change Uploaded 2014-06-16 Available
SupSta B.docx Supporting Statement B Uploaded 2014-03-25 Available
Att 2 60 Day FRN.pdf Supplementary Document Uploaded 2014-03-25 Repair queued
Att 1_Auth Legislation.pdf Supplementary Document Uploaded 2014-03-25 Available
SS A_0920-1019.docx Supporting Statement A Uploaded 2014-06-16 Available
IC Document Collections
IC IDCollectionTypeStatusForm
210980 Pharmacy Record Abstraction Form Other-WORD Unchanged
210979 Quarterly Patient Information Form Instruction Unchanged
210978 Initial Patient Information Form Instruction Unchanged
210977 Patient Demographic Information Form Other-WORD Unchanged
210976 Project Pharmacy Characteristics Form Other-WORD Unchanged
210975 Project Clinic Characteristics Form Other-WORD Unchanged
ICR Details
0920-1019 201406-0920-009
Historical Active 201403-0920-016
HHS/CDC 21630
Integrating Community Pharmacists and Clinical Sites for Patient-Centered HIV Care
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 07/17/2014
Retrieve Notice of Action (NOA) 06/23/2014
Prior terms of clearance still apply.
  Inventory as of this Action Requested Previously Approved
05/31/2017 05/31/2017 05/31/2017
10,060 0 10,060
5,113 0 5,113
0 0 0
This change request includes providing an information sheet to the participants rather than a consent form as the clients have consented before they receive care at the clinic. There is no change in burden.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  78 FR 36550 06/18/2013
79 FR 16002 03/24/2014
No
  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 10,060 10,060 0 0 0 0
Annual Time Burden (Hours) 5,113 5,113 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
This is a NEW collection request for a new OMB Control Number.
$990,016
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.
06/23/2014