OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Performance Monitoring of “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations

ICR 201607-0920-001 · OMB 0920-1156 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Youth Serving Organization (YSO) Staff Survey Form and Instruction New Repair queued
Youth Serving Organization (YSO) Performance Measure Reporting Tool Form and Instruction New Repair queued
Youth Serving Organization (YSO) Organizational Assessment Form and Instruction New Available
Health Center Provider Survey Form and Instruction New Available
Annual Health Center Performance Measure Reporting Tool Form and Instruction New Available
Quarterly Health Center Perfoemance Measure Reporting Tool Form and Instruction New Repair queued
Health Center Organizational Assessment Form and Instruction New Available
Health Center Youth Survey Form and Instruction New Available
Awardee Performance Measure Reporting Tool Form and Instruction New Available
Awardee Training and Techmnical Assistance Tool Form and Instruction New Repair queued
Youth Serving Organization (YSO) Staff Survey Form and Instruction New Available
Youth Serving Organization (YSO) Performance Measure Reporting Tool Form and Instruction New Available
Youth Serving Organization (YSO) Organizational Assessment Form and Instruction New Repair queued
Health Center Provider Survey Form and Instruction New Available
Annual Health Center Performance Measure Reporting Tool Form and Instruction New Available
Quarterly Health Center Performance Measure Reporting Tool Form and Instruction New Available
Health Center Organizational Assessment Form and Instruction New Repair queued
SS Part B_6 29 2016.docx Supporting Statement B Uploaded 2016-07-12 Available
SS Part A_6 29 2016.docx Supporting Statement A Uploaded 2016-07-12 Available
Att 14 logic model.docx Supplementary Document Uploaded 2016-07-12 Available
Att 3 Crosswalk of Objectives and Data Sources_4-7-2016.docx Supplementary Document Uploaded 2016-07-12 Available
684_Working iwth Publicly funded HCs to reduce TPP.pdf Supplementary Document Uploaded 2016-07-12 Available
Att 2b 0902-16MM Public Comment.txt Supplementary Document Uploaded 2016-07-07 Available
Att 2a 0920-16MM 60-day FRN.pdf Supplementary Document Uploaded 2016-07-07 Available
Att 1-Authorizing Legislation.pdf Supplementary Document Uploaded 2016-07-07 Available
IC Document Collections
IC IDCollectionTypeStatusForm
222392 Youth Serving Organization (YSO) Staff Survey Form and Instruction New
222389 Youth Serving Organization (YSO) Performance Measure Reporting Tool Form and Instruction New
222387 Youth Serving Organization (YSO) Organizational Assessment Form and Instruction New
222386 Health Center Provider Survey Form and Instruction New
222376 Annual Health Center Performance Measure Reporting Tool Form and Instruction New
222375 Quarterly Health Center Perfoemance Measure Reporting Tool Form and Instruction New
222374 Health Center Organizational Assessment Form and Instruction New
222373 Health Center Youth Survey Form and Instruction New
222372 Awardee Performance Measure Reporting Tool Form and Instruction New
222371 Awardee Training and Techmnical Assistance Tool Form and Instruction New
222370 Youth Serving Organization (YSO) Staff Survey Form and Instruction New
222369 Youth Serving Organization (YSO) Performance Measure Reporting Tool Form and Instruction New
222368 Youth Serving Organization (YSO) Organizational Assessment Form and Instruction New
222367 Health Center Provider Survey Form and Instruction New
222366 Annual Health Center Performance Measure Reporting Tool Form and Instruction New
222365 Quarterly Health Center Performance Measure Reporting Tool Form and Instruction New
222364 Health Center Organizational Assessment Form and Instruction New
ICR Details
0920-1156 201607-0920-001
Historical Active
HHS/CDC 0920-16MM
Performance Monitoring of “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 01/19/2017
Retrieve Notice of Action (NOA) 07/13/2016
Approved consistent with the understanding that this collection will measure outcomes intended to facilitate program improvement and development. Collection activities are not intended to produce generalizable outcomes regarding teen pregnancy or reproductive health.
  Inventory as of this Action Requested Previously Approved
01/31/2020 36 Months From Approved
2,064 0 0
1,150 0 0
0 0 0
To evaluate and improve efforts of three organizations under the cooperative agreement “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Vulnerable Populations” to 1) work with health centers to enhance implementation of best practices in adolescent reproductive health care and 2) work with youth-serving organizations (YSOs) to develop systematic approaches to referring youth at risk for a teen pregnancy to reproductive health care. Information collected will be used to monitor awardee performance and determine training and technical assistance needs to address any performance issues.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  81 FR 6270 02/05/2016
81 FR 45166 07/12/2016
Yes
17
IC Title Form No. Form Name
Youth Serving Organization (YSO) Performance Measure Reporting Tool NA Youth Serving Organization (YSO) Performance Measure Reporting Tool
Annual Health Center Performance Measure Reporting Tool NA Annual Health Center Performance Measure Reporting Tool
Youth Serving Organization (YSO) Performance Measure Reporting Tool NA Youth Serving Organization Performance Measure Reporting Tool
Youth Serving Organization (YSO) Staff Survey NA Youth Serving Organization Staff Survey
Awardee Performance Measure Reporting Tool NA Awardee Performance Measure Reporting Tool
Annual Health Center Performance Measure Reporting Tool NA Annual Health Center Performance Measure Reporting Tool
Health Center Organizational Assessment NA Health Center Organizational Assessment
Quarterly Health Center Performance Measure Reporting Tool NA Quarterly Health Center Performance Measure Reporting Tool
Health Center Provider Survey NA Health Center Provider Survey
Youth Serving Organization (YSO) Staff Survey NA Youth Serving Organization (YSO) Staff Survey
Health Center Provider Survey NA Health Center Provider Survey
Youth Serving Organization (YSO) Organizational Assessment NA Youth Serving Organization (YSO) Organizational Assessment
Youth Serving Organization (YSO) Organizational Assessment NA Youth Serving Organization (YSO) Organizational Assessment
Awardee Training and Techmnical Assistance Tool NA Awardee Training and Technical Assistance Tool
Health Center Youth Survey NA Helath Center Youth Survey
Quarterly Health Center Perfoemance Measure Reporting Tool NA Quarterly Health Center Performance Measure Reporting Tool
Health Center Organizational Assessment NA Health Center Organizational Assessment
  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 2,064 0 0 2,064 0 0
Annual Time Burden (Hours) 1,150 0 0 1,150 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
Submission of 0920-16MM is a New ICR.
$232,215
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Jeffrey Zirger 404 639-7118 [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.
07/13/2016