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 201703-0920-010 · OMB 0920-1156 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Youth Serving Organization (YSO) Staff Survey Form and Instruction Unchanged Available
Youth Serving Organization (YSO) Performance Measure Reporting Tool Form Modified Available
Youth Serving Organization (YSO) Organizational Assessment Form Modified Available
Health Center Provider Survey Form and Instruction Unchanged Available
Annual Health Center Performance Measure Reporting Tool Form and Instruction Modified Available
Quarterly Health Center Perfoemance Measure Reporting Tool Form and Instruction Unchanged Available
Health Center Organizational Assessment Form and Instruction Unchanged Repair queued
Health Center Youth Survey Form and Instruction Unchanged Available
Awardee Performance Measure Reporting Tool Form and Instruction Modified Available
Awardee Training and Techmnical Assistance Tool Form and Instruction Unchanged Available
Youth Serving Organization (YSO) Staff Survey Form and Instruction Modified Available
Youth Serving Organization (YSO) Performance Measure Reporting Tool Form and Instruction Unchanged Available
Youth Serving Organization (YSO) Organizational Assessment Form and Instruction Modified Available
Health Center Provider Survey Form and Instruction Modified Available
Annual Health Center Performance Measure Reporting Tool Form and Instruction Modified Available
Quarterly Health Center Performance Measure Reporting Tool Form and Instruction Modified Repair queued
Health Center Organizational Assessment Form and Instruction Modified Available
0920-1156 Change Request Justification.docx Justification for No Material/Nonsubstantive Change Uploaded 2017-03-21 Available
SS Part B_6 29 2016.docx Supporting Statement B Uploaded 2016-07-12 Available
REV SS Part A_Working with Public Centers TPP_03_7_2017_clean.docx Supporting Statement A Uploaded 2017-03-21 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 Repair queued
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 Unchanged
222389 Youth Serving Organization (YSO) Performance Measure Reporting Tool Form Modified
222387 Youth Serving Organization (YSO) Organizational Assessment Form Modified
222386 Health Center Provider Survey Form and Instruction Unchanged
222376 Annual Health Center Performance Measure Reporting Tool Form and Instruction Modified
222375 Quarterly Health Center Perfoemance Measure Reporting Tool Form and Instruction Unchanged
222374 Health Center Organizational Assessment Form and Instruction Unchanged
222373 Health Center Youth Survey Form and Instruction Unchanged
222372 Awardee Performance Measure Reporting Tool Form and Instruction Modified
222371 Awardee Training and Techmnical Assistance Tool Form and Instruction Unchanged
222370 Youth Serving Organization (YSO) Staff Survey Form and Instruction Modified
222369 Youth Serving Organization (YSO) Performance Measure Reporting Tool Form and Instruction Unchanged
222368 Youth Serving Organization (YSO) Organizational Assessment Form and Instruction Modified
222367 Health Center Provider Survey Form and Instruction Modified
222366 Annual Health Center Performance Measure Reporting Tool Form and Instruction Modified
222365 Quarterly Health Center Performance Measure Reporting Tool Form and Instruction Modified
222364 Health Center Organizational Assessment Form and Instruction Modified
ICR Details
0920-1156 201703-0920-010
Historical Active 201607-0920-001
HHS/CDC 0920-16MM
Performance Monitoring of “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 03/23/2017
Retrieve Notice of Action (NOA) 03/22/2017
Previous terms continue: 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 01/31/2020 01/31/2020
2,064 0 2,064
1,150 0 1,150
0 0 0
CDC obtained the current approval in January 2017. Since submitting the 30 day notice and accompanying materials in June 2016, CDC identified funds that allowed us to support development of an online data collection system intended to make responding simpler by utilizing automatic skip patterns while also simplifying data submission. In the process of developing the online data collection system, we noted places in the currently approved measures that would need slight modifications (e.g., small changes to directions, changing from a table to a question format) in order to function correctly in the online measures. We also noted places where the measures could be made clearer. As a result, CDC is now requesting approval of these minor changes to the previously approved versions of the measures that were created in word. There is no change in burden associated with these changes.
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) Staff Survey NA Youth Serving Organization (YSO) Staff Survey
Health Center Provider Survey NA Health Center Provider Survey
Youth Serving Organization (YSO) Organizational Assessment N/A Att 9a YSO Organizational Assessment Online Version
Youth Serving Organization (YSO) Performance Measure Reporting Tool N/A Att 11a YSO Performance Measure Reporting Tool Online Version
Annual Health Center Performance Measure Reporting Tool N/A, N/A Att 8 Annual Health Center Performance Measure Reporting Tool clean ,   Att 8a Annual Health Center Performance Measure Reporting Tool Online Version
Youth Serving Organization (YSO) Performance Measure Reporting Tool NA Youth Serving Organization Performance Measure Reporting Tool
Youth Serving Organization (YSO) Staff Survey N/A, N/A Att 10 YSO Staff Survey clean ,   Att 10a YSO Staff Survey Online Version
Awardee Performance Measure Reporting Tool N/A, N/A Att 13 Awardee Performance Measure Reporting Tool clean ,   Att 13a Awardee Performance Measure Reporting Tool Online Version
Annual Health Center Performance Measure Reporting Tool N/A, N/A Att 8 Annual Health Center Perfornce Meure Repting Tool clean ,   Att 8a Annual Health Center Performance Measure Reporting Tool Online Version
Health Center Organizational Assessment N/A, N/A Att 4 Health Center Organizational Assessment 03_01_2017 clean ,   Att 4a Health Center Organizational Assessment Online Version
Quarterly Health Center Performance Measure Reporting Tool N/A, N/A Att 7 Quarterly Health Center Performance Measure Reporting Tool clean ,   Att 7a Quarterly Health Center Performance Measure Reporting Tool Online Version
Health Center Provider Survey N/A, N/A Att 5 Health Center Provider Survey clean ,   Att 5a Health Center Provider Survey Online Version
Youth Serving Organization (YSO) Organizational Assessment N/A, N/A Att 6a Health Center Youth Survey Online Version ,   Att 6a Health Center Youth Survey Online Version
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 2,064 0 0 0 0
Annual Time Burden (Hours) 1,150 1,150 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$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.
03/22/2017