Evaluation of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Quality Demonstration Grant Program

Forms and Documents

Document Name	Status
Form Form #5 Non-demonstration States Interviews Form and Instruction	New
Form Form #4 Health Care Provider Interviews Form and Instruction	New
Form Form #3 Stakeholder Interviews Form and Instruction	New
Form Form #2 Implementation Staff Interviews Form and Instruction	New
Form Form #1 Key Staff Interviews Form and Instruction	New
CHIPRASupporting Statement Part B -- Revised Feb 8-1.docx Supporting Statement B	2012-02-16
Attachment J -- Confidentiality Pledge.docx Supplementary Document	2011-10-12
Attachment I -- TEP Members.docx Supplementary Document	2011-10-12
Attachment H -- Federal Register Notice.pdf Supplementary Document	2011-10-12
Attachment G_ Interview Request&Confirmation.docx Supplementary Document	2012-02-16
Attachment A - Authorizing Legislation.docx Supplementary Document	2012-02-16
CHIPRASupporting Statement Part A -- Revised Feb 15.docx Supporting Statement A	2012-02-16

IC Document Collections

IC ID	Document Title	Status
199924	Non-demonstration States Interviews Form and Instruction	New
199923	Health Care Provider Interviews Form and Instruction	New
199922	Stakeholder Interviews Form and Instruction	New
199921	Implementation Staff Interviews Form and Instruction	New
199920	Key Staff Interviews Form and Instruction	New

ICR Details

OMB Control No: 0935-0190	ICR Reference No: 201110-0935-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: Evaluation of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Quality Demonstration Grant Program
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/17/2012
	Date Received in OIRA: 10/27/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2015	36 Months From Approved
Responses	837	0	0
Time Burden (Hours)	855	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 401(a) of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Pub. L. 111-3, amended the Social Security Act (the Act) to enact section 1139A (42 U.S.C. 1320b-9a). AHRQ is requesting approval from the Office of Management and Budget (OMB) for data collection to support a national evaluation of the quality demonstration grants authorized under section 1139A(d) of the Act. Evaluating whether the CHIPRA demonstration grants improve the quality of care received by children in Medicaid and CHIP aligns with AHRQ's mission of improving the quality and effectiveness of health care in the United States.

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 46809	08/03/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 62410	10/07/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Key Staff Interviews	Form #1	Key Staff Interview Guide
Implementation Staff Interviews	Form #2	Implementation Satff Interview Guide
Stakeholder Interviews	Form #3	Stakeholder Interview Guide
Health Care Provider Interviews	Form #4	Health Care Provider Interview Guide
Non-demonstration States Interviews	Form #5	Other States Interview Guide

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ICR Summary of Burden

	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	837	0	0	837	0	0
Annual Time Burden (Hours)	855	0	0	855	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection request.

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Annual Cost to Federal Government: $1,712,923

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Yes

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 10/27/2011

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