OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

OPRE Evaluation - National and Tribal Evaluation of the 2nd Generation of the Health Profession Opportunity Grants [descriptive evaluation, impact evaluation, cost-benefit analysis study, pilot study]

ICR 202004-0970-009 · OMB 0970-0462 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
OMB#0970-0462_NonSub Change Request_Temporary Use of Verbal Consent Forms_04152020.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-04-16 Repair queued
Attachment B3_Tribal Evaluation informed consent Form D (Unique Identifiers_Verbal.docx Supplementary Document Uploaded 2020-04-16 Repair queued
Attachment B2_Tribal Evaluation_informed consent Form C (SSNs)_VERBAL.DOCX Supplementary Document Uploaded 2020-04-16 Available
Attachment B_National Evaluation informed consent Form D_ lottery not required-Verbal.docx Supplementary Document Uploaded 2020-04-16 Repair queued
Attachment B. National Evaluation Informed Consent Form C Lottery Required _Verbal.docx Supplementary Document Uploaded 2020-04-16 Repair queued
Attachment Z_ Participant Interview Recruitment Materials.docx Supplementary Document Uploaded 2019-04-18 Available
Attachment Y 60-Day Federal Register Notice.pdf Supplementary Document Uploaded 2019-04-18 Available
Attachment X_Complete List of Previously Approved Instruments for HPOG 2.0.docx Supplementary Document Uploaded 2019-04-18 Repair queued
Attachment W_HPOG 2.0_phone based Skills Assessment Pilot_Recruitment Script.docx Supplementary Document Uploaded 2019-04-18 Repair queued
Attachment V_HPOG 2.0_phone based Skills Assessment Pilot_ParticipantLetter.docx Supplementary Document Uploaded 2019-04-18 Repair queued
Attachment U_HPOG 2.0_phone based Skills Assessment Pilot_Grantee Letter.docx Supplementary Document Uploaded 2019-04-18 Available
Attachment T_HPOG 2.0_phone based Skills Assessment Pilot_Recruitment Flyer.docx Supplementary Document Uploaded 2019-04-18 Repair queued
Attachment S_HPOG 2.0_Intermediate Follow-up Email Reminder.docx Supplementary Document Uploaded 2019-04-18 Available
Attachment R_HPOG 2.0_Intermediate Follow-upSurvey_Flyer.docx Supplementary Document Uploaded 2019-04-18 Repair queued
Attachment Q_HPOG 2.0 Intermeditate Follow-up Survey Sources.docx Supplementary Document Uploaded 2019-04-18 Available
Attachment P_HPOG 2.0_Intermediate Follow-up Survey Advance Letter.docx Supplementary Document Uploaded 2019-04-18 Available
Attachment O_ResearchQuestions for Previously Approved National and Tribal Evaluation Efforts.docx Supplementary Document Uploaded 2018-02-01 Repair queued
Attachment N_HPOG2.0_Short-Term Followup Short-Term Survey_ Email Remind_revised_010918_clean.docx Supplementary Document Uploaded 2018-02-01 Available
Attachment M_HPOG 2.0_Short-Term Survey Flyer 01092018.docx Supplementary Document Uploaded 2018-02-01 Available
Attachment L_HPOG 2.0 Short-Term Followup Followup Survey Sources_Rev_121217_Clean.docx Supplementary Document Uploaded 2018-02-01 Available
Attachment K_HPOG2.0_Short-Term Followup Survey Advance Letter_Rev_01092018_Clean.docx Supplementary Document Uploaded 2018-02-01 Available
Attachment K_HPOG 2 0 Incentive Communications_Email and Letter_071117 CLEAN.docx Supplementary Document Uploaded 2017-07-12 Repair queued
Attachment J_Interview Verbal Informed Consent Form.docx Supplementary Document Uploaded 2016-10-24 Repair queued
Attachment I_Focus Group Informed Consent Form.doc Supplementary Document Uploaded 2016-10-24 Repair queued
Attachment H_HPOG- Model.pptx Supplementary Document Uploaded 2016-10-24 Available
Attachment B3_Tribal Evaluation Informed Consent Form B (Unique Identifiers).docx Supplementary Document Uploaded 2016-06-16 Repair queued
Attachment B2_Tribal Evaluation Informed Consent Form A (SSNs).docx Supplementary Document Uploaded 2016-06-16 Available
Attachment B_Approved non-tribal, adult lottery not required consent form.docx Supplementary Document Uploaded 2016-06-16 Available
Attachment A_References_Revised 09 02 16.docx Supplementary Document Uploaded 2016-10-24 Available
Attachment G. Contact Update Letter and Form.docx Supplementary Document Uploaded 2015-05-11 Repair queued
HPOG 2.0_Supporting Statement B_Revised_04152020_Temporary Approval of Verbal Consent.docx Supporting Statement B Uploaded 2020-04-16 Repair queued
HPOG 2.0_Supporting Statement A_Revised_04152020_Temporary Approval of Verbal Consent.docx Supporting Statement A Uploaded 2020-04-16 Repair queued
Attachment F. First Round of HPOG Grantees Ressearch Portfolio_4.28.15.docx Supplementary Document Uploaded 2015-05-06 Available
FINAL updated Attachment E PPR Data List and Mockup 8 4 15 clean.docx Supplementary Document Uploaded 2015-08-05 Available
Attachment D. Sources and Justification_5.4.15.docx Supplementary Document Uploaded 2015-05-06 Available
Attachment C_HPOG 2.0 15 mos follow up - 60 Day FRN_8.30.17.pdf Supplementary Document Uploaded 2018-02-01 Available
Attachment B. Informed Consent Forms_01.25.16 clean.docx Supplementary Document Uploaded 2016-01-26 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
235782 Instrument 20: Program cost survey Other-Survey Unchanged
235781 Instrument 19: Phone-based Skills Assessment Pilot Instrument Other-Phone-based Assessment Unchanged
235780 Instrument 18: Intermediate Follow-up Survey for the National Evaluation impact study Other-Survey Unchanged
235779 Instrument 17: Participant interview guide Other-Interview Guide Unchanged
235778 Instrument 16: Partner interview guide for the systems study Other-Interview Guide Unchanged
235777 Instrument 15: Program operator interview guide for the systems study Other-Interview Guide Unchanged
235776 Instrument 14: Second round telephone interview protocol for non-tribal HPOG grantee staff and partners Other-Interview Guide Modified
235775 Instrument 13: Screening tool for identifying respondents for second-round telephone interviews Other-Screener Unchanged
229940 Instrument 12: Short-Term Follow-up Survey for the HPOG 2.0 National Evaluation Impact Evaluation Other-Survey Unchanged
229938 Instrument 5b: HPOG 2.0 National Evaluation letter and participant contact update form Other-Update Form Unchanged
224119 Instrument 11: HPOG 2.0 Tribal Evaluation program participant non-completer interviews Other-Interview Unchanged
224118 Instrument 10: HPOG 2.0 Tribal Evaluation program participant completer interviews Other-Interview Unchanged
224113 Instrument 9: HPOG 2.0 Tribal Evaluation program participant focus groups Other-Focus Group Unchanged
224112 Instrument 8: HPOG 2.0 Tribal Evaluation employer interviews Other-Interview Unchanged
224110 Instrument 7: HPOG 2.0 Tribal Evaluation program implementation staff interviews Other-Interview Unchanged
224107 Instrument 6: HPOG 2.0 Tribal Evaluation grantee and partner administrative staff interviews Other-Interview Unchanged
216432 PAGES Participant-Level Baseline Data Collection (participants at Tribal grantees) Other-Data collection System Unchanged
216431 PAGES Participant-Level Baseline Data Collection (participants at non-Tribal grantees participating in impact study) Other-Data collection System Unchanged
216430 PAGES Grantee- and Participant-Level Data Collection (all grantees) Other-Data collection System Unchanged
ICR Details
0970-0462 202004-0970-009
Historical Active 201904-0970-006
HHS/ACF OPRE
OPRE Evaluation - National and Tribal Evaluation of the 2nd Generation of the Health Profession Opportunity Grants [descriptive evaluation, impact evaluation, cost-benefit analysis study, pilot study]
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 04/23/2020
Retrieve Notice of Action (NOA) 04/16/2020
  Inventory as of this Action Requested Previously Approved
07/31/2022 07/31/2022 07/31/2022
21,040 0 21,040
9,780 0 9,780
0 0 0
The Health Profession Opportunity Grants (HPOG) Program provides healthcare occupational training for Temporary Assistance for Needy Families (TANF) recipients and other low-income people. Under normal study enrollment procedures, local HPOG 2.0 grantee staff conduct face-to-face intake interviews and administer informed consent. As part of the consent process, study participants sign the form in ink. As a result of the recent COVID-19 outbreak, most HPOG programs have changed to operate their programs virtually, including asking staff to work remotely and offering participant trainings online. These restrictions have brought the face-to-face intake and enrollment sessions to a sudden halt in many locations. However, grantees are eager to continue enrollment in the interest of serving the healthcare workforce needs in their communities. In order to facilitate grantees’ continued enrollment of new participants while their programs operate remotely, we have developed a new set of consent forms to allow grantee staff to obtain informed consent verbally. The new set of forms include only minor revisions from the already approved versions for written consent to allow for verbal consent. • Attachment B: National Evaluation informed consent form C (Lottery Required)_Verbal • Attachment B: National Evaluation informed consent form D (Lottery Not Required)_Verbal • Attachment B2: Tribal Evaluation informed consent form C (SSNs)_Verbal • Attachment B3: Tribal Evaluation informed consent form D (Unique identifiers)_Verbal
PL: Pub.L. 111 - 148 5507 , sec. 2008, (a)(3)(B) Name of Law: Patient Protection and Affordable Care Act
  
None
Not associated with rulemaking
  83 FR 66715 12/27/2018
84 FR 16870 04/23/2019
No
19
IC Title Form No. Form Name
Instrument 13: Screening tool for identifying respondents for second-round telephone interviews
Instrument 15: Program operator interview guide for the systems study
Instrument 18: Intermediate Follow-up Survey for the National Evaluation impact study
Instrument 20: Program cost survey
Instrument 9: HPOG 2.0 Tribal Evaluation program participant focus groups
Instrument 6: HPOG 2.0 Tribal Evaluation grantee and partner administrative staff interviews
Instrument 7: HPOG 2.0 Tribal Evaluation program implementation staff interviews
Instrument 8: HPOG 2.0 Tribal Evaluation employer interviews
Instrument 10: HPOG 2.0 Tribal Evaluation program participant completer interviews
Instrument 11: HPOG 2.0 Tribal Evaluation program participant non-completer interviews
PAGES Participant-Level Baseline Data Collection (participants at non-Tribal grantees participating in impact study)
PAGES Grantee- and Participant-Level Data Collection (all grantees)
PAGES Participant-Level Baseline Data Collection (participants at Tribal grantees)
Instrument 5b: HPOG 2.0 National Evaluation letter and participant contact update form
Instrument 12: Short-Term Follow-up Survey for the HPOG 2.0 National Evaluation Impact Evaluation
Instrument 14: Second round telephone interview protocol for non-tribal HPOG grantee staff and partners
Instrument 16: Partner interview guide for the systems study
Instrument 17: Participant interview guide
Instrument 19: Phone-based Skills Assessment Pilot Instrument
  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 21,040 21,040 0 0 0 0
Annual Time Burden (Hours) 9,780 9,780 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$4,717,923
No
    Yes
    No
Yes
No
No
Yes
Molly Buck 202 205-4724 [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.
04/16/2020