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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 202105-0970-010 · OMB 0970-0462 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Attachment AA_HPOG2.0_ParticipantNewsletter.docx Supplementary Document Uploaded 2021-05-19 Repair queued
Attachment N_Revised COVID-19 Short-Term Survey Email Reminder Text.docx Supplementary Document Uploaded 2021-05-19 Repair queued
Attachment M_Revised COVID-19 Cohort Short-term Survey Trying to Reach You Flyer.docx Supplementary Document Uploaded 2021-05-19 Repair queued
Attachment L_Revised COVID-19 Cohort Short-Term Survey Souces.docx Supplementary Document Uploaded 2021-05-19 Repair queued
Attachment K_Revised COVID-19 Cohort Short-Term Survey Advance Letter.docx Supplementary Document Uploaded 2021-05-19 Repair queued
Attachment B3_Tribal Evaluation Informed Consent Form B (Unique Identifiers).docx Supplementary Document Uploaded 2020-06-24 Repair queued
Attachment B2_Tribal Evaluation Informed Consent Form A (SSNs).docx Supplementary Document Uploaded 2020-06-24 Repair queued
Attachment B. National Evaluation Informed Consent Forms A_Lottery Required_REV.docx Supplementary Document Uploaded 2020-06-24 Repair queued
Attachment B3_Tribal Evaluation informed consent Form D Unique Identifiers_Verbal.docx Supplementary Document Uploaded 2020-06-24 Repair queued
Attachment B2_Tribal Evaluation_informed consent Form C SSNs_Verbal.docx Supplementary Document Uploaded 2020-06-24 Repair queued
Attachment B. National Evaluation Informed Consent Form C Lottery Required _Verbal_REV.docx Supplementary Document Uploaded 2020-06-24 Repair queued
Attachment S_HPOG 2.0_Intermediate Follow-up Email Reminder_REV.docx Supplementary Document Uploaded 2020-06-24 Repair queued
Attachment R_HPOG 2.0_Intermediate Follow-upSurvey_Flyer.docx Supplementary Document Uploaded 2019-04-18 Repair queued
Attachment Q_HPOG 2.0 Intermediate Follow-up Survey Sources_REV.docx Supplementary Document Uploaded 2020-06-24 Repair queued
Attachment P_HPOG 2.0_Intermediate Follow-up Survey Advance Letter_REV.docx Supplementary Document Uploaded 2020-06-24 Repair queued
HPOG2.0_CovidCohortSurvey_LT-Tracking SSB_Rev_051321.docx Supporting Statement B Uploaded 2021-05-19 Repair queued
HPOG 2 CovidCohortSurvey_LT-Tracking_SSA_Rev_051921.docx Supporting Statement A Uploaded 2021-05-19 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
247514 Instrument 12a: COVID-19 Cohort STS Other-Survey New
244488 Instrument 5a: HPOG 2.0 National Evaluation Welcome to the Study Packet Other-Welcome Packet Modified
242412 Instrument 18a: Intermediate Follow-up Survey for the National Evaluation impact study - Critical Items Only Other-Survey Modified
235780 Instrument 18: Intermediate Follow-up Survey for the National Evaluation impact study Other-Survey Modified
229938 Instrument 5b: HPOG 2.0 National Evaluation letter and participant contact update form Other-Update Form Modified
224119 Instrument 11: HPOG 2.0 Tribal Evaluation program participant non-completer interviews Other-Interview Removed
224118 Instrument 10: HPOG 2.0 Tribal Evaluation program participant completer interviews Other-Interview Removed
224113 Instrument 9: HPOG 2.0 Tribal Evaluation program participant focus groups Other-Focus Group Removed
224112 Instrument 8: HPOG 2.0 Tribal Evaluation employer interviews Other-Interview Removed
224110 Instrument 7: HPOG 2.0 Tribal Evaluation program implementation staff interviews Other-Interview Removed
224107 Instrument 6: HPOG 2.0 Tribal Evaluation grantee and partner administrative staff interviews Other-Interview Removed
216432 PAGES Participant-Level Baseline Data Collection (participants at Tribal grantees) Other-Data collection System Modified
216431 PAGES Participant-Level Baseline Data Collection (participants at non-Tribal grantees participating in impact study) Other-Data collection System Modified
216430 PAGES Grantee- and Participant-Level Data Collection (all grantees) Other-Data collection System Modified
ICR Details
0970-0462 202105-0970-010
Received in OIRA 202105-0970-005
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]
Revision of a currently approved collection   No
Regular 05/21/2021
  Requested Previously Approved
36 Months From Approved 07/31/2022
11,815 27,783
4,525 9,143
0 0
This is the fourth request for revisions to OMB #0970-0462. This revised request for clearance seeks approval for: 1. COVID-19 Cohort Short-term Survey (COVID-19 Cohort STS): This survey is a revised version of the previously approved Short-term Follow-Up Survey. The goal is to measure the short-term impacts of HPOG 2.0 for study participants enrolled after the onset of the COVID-19 pandemic (May 2020-September 2021). This will help us understand the impact of COVID-19 on program operations and participant outcomes. This also includes revisions to the supplemental materials associated with this data collection. 2. New supporting materials to support the re-engagement of participants selected for a long-term follow-up survey of HPOG 2.0 participants—a newsletter and an outbound call script for collecting updated contact data, both of which will help enhance the contact information update procedures previously approved under OMB #0970-0462.
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
  85 FR 83586 12/22/2020
86 FR 27624 05/21/2021
No
  Total Request 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 11,815 27,783 0 -15,968 0 0
Annual Time Burden (Hours) 4,525 9,143 0 -4,618 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
This request for clearance is for a new information collection under OMB #0970-0462, the COVID-19 STS (Instrument #12a). This request does not include any changes in burden to previously approved instruments but does reflect the completion of some data collection activities (as described previously in this supporting statement).
$2,915,650
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.
05/21/2021