Health Profession Opportunity Grants (HPOG) program

Forms and Documents

Document Name	Status
Appendix I Survey Advance Letter clean.docx Supplementary Document	2014-12-03
Appendix H Contact Update Letter and Form REVISED clean.docx Supplementary Document	2014-12-03
Appendix D HPOG Impact 36-mo Followup Table of Contents REVISED clean.docx Supplementary Document	2014-12-03
Appendix A HPOG Logic Model - Revised - clean.docx Supplementary Document	2014-12-03
Previously Submitted Appendix_Information on the Full ISIS Sample Frame.docx Supplementary Document	2014-08-22
Previously Approved Tracking Letter and Contact Update form.docx Supplementary Document	2014-08-22
Previously Approved Supplementary Documents.pdf Supplementary Document	2014-08-22
Previously Approved HPOG-Impact and HPOG-NIE Advance letter.docx Supplementary Document	2014-08-22
Previously Approved Consent Forms for Participant Surveys 5-2.pdf Supplementary Document	2014-08-22
HPOG-ISIS Questions by Research Obj 7 26 13.xlsx Supplementary Document	2013-08-07
HPOG NIE and Impact Supporting Statement_Part B REVISED 111814 clean.docx Supporting Statement B	2014-12-03
HPOG NIE and Impact Supporting Statement_Part A REVISED 111814 clean.docx Supporting Statement A	2014-12-03

IC Document Collections

IC ID	Document Title	Status
212776	HPOG-NIE Performance Measurement Semi-Structured Discussion Guide Other-Discussion Guide	New
212775	HPOG-NIE Performance Measurement Screening Questionnaire Other-Screener	New
212774	HPOG-Impact 36-month Control Group Member Follow-Up survey Other-Survey	New
212773	HPOG-Impact 36-month Participant Follow-Up survey Other-Survey	New
206801	HPOG-NIE 15-month Participant Follow-Up survey Other-Survey	Modified
206800	HPOG-Impact 15-month Control Group Member Follow-Up survey Other-Survey	Modified
206799	HPOG-Impact 15-month Participant Follow-Up survey Other-Survey	Modified
206798	HPOG-NIE Employer survey Other-Survey	Removed
206797	HPOG-NIE Stakeholder/Network survey Other-Survey	Removed
206796	HPOG-NIE Management and Staff survey Other-Survey	Removed
206795	HPOG-Impact Implementation interview guide for HPOG program staff Other-Interview Guide	Removed
206794	HPOG-Impact Implementation interview guide for HPOG program management Other-Interview Guide	Removed
206793	HPOG-Impact Implementation interview guide for instructors Other-Interview Guide	Removed
206792	HPOG-Impact Implementation interview guide for partnering employers Other-Interview Guide	Removed
206791	HPOG-NIE Grantee survey Other-Survey	Removed
206790	HPOG-NIE Follow-Up Phone Call Protocol for the Stakeholder/Network survey Other-Questionnaire	Removed
206789	HPOG-NIE Sampling Questionnaire for the HPOG surveys Other-Questionnaire	Removed
202865	Supplemental Baseline Questions (grantees) Other-Supplemental Questions	Removed
202864	Supplemental Baseline Questions (program participants and control group members) Other-Supplemental Questions	Removed
198341	Semi-annual HPOG Program Performance Report Other-Word	Modified

ICR Details

OMB Control No: 0970-0394	ICR Reference No: 201408-0970-008
Status: Historical Active	Previous ICR Reference No: 201305-0970-001
Agency/Subagency: HHS/ACF	Agency Tracking No: 19416
Title: Health Profession Opportunity Grants (HPOG) program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/03/2014
	Date Received in OIRA: 09/09/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	36 Months From Approved	08/31/2016
Responses	5,966	0	15,929
Time Burden (Hours)	6,292	0	8,212
Cost Burden (Dollars)	0	0	0

---

Abstract: ACF is implementing a multi-pronged research and evaluation approach for the HPOG program to better understand and assess the activities conducted and their results. The current submission is in support of the HPOG Impact Study (HPOG-Impact) and the HPOG National Implementation Evaluation (HPOG-NIE). Specifically, ACF seeks approval for 36-month follow up data collection for HPOG-Impact and for follow-on HPOG-NIE data collection activities. All 27 HPOG grantees serving TANF recipients and other low-income individuals are participating in HPOG-NIE; 20 are participating in HPOG-Impact. HPOG-Impact and HPOG-NIE are two projects within the broader portfolio of research that OPRE is utilizing to assess the success of the career pathways programs and models. This strategy includes a multi-pronged research and evaluation approach for the HPOG program to better understand and assess the activities conducted and their results as well as the Innovative Strategies for Improving Self-Sufficiency (ISIS) project. In order to maximize learning across the portfolio, survey development for the HPOG and ISIS baseline and follow up surveys is being coordinated, and the majority of the data elements collected in these surveys are similar.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 5507 Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 35547	06/23/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 51174	08/27/2014
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 8

IC Title	Form No.	Form Name
Supplemental Baseline Questions (program participants and control group members)
Supplemental Baseline Questions (grantees)
HPOG-NIE Sampling Questionnaire for the HPOG surveys
HPOG-NIE Follow-Up Phone Call Protocol for the Stakeholder/Network survey
HPOG-Impact 15-month Control Group Member Follow-Up survey
HPOG-NIE 15-month Participant Follow-Up survey
HPOG-Impact 36-month Participant Follow-Up survey
HPOG-Impact 36-month Control Group Member Follow-Up survey
HPOG-NIE Performance Measurement Screening Questionnaire
HPOG-NIE Performance Measurement Semi-Structured Discussion Guide
HPOG-NIE Grantee survey
HPOG-Impact Implementation interview guide for partnering employers
HPOG-Impact Implementation interview guide for instructors
HPOG-Impact Implementation interview guide for HPOG program management
HPOG-Impact Implementation interview guide for HPOG program staff
HPOG-NIE Management and Staff survey
HPOG-NIE Stakeholder/Network survey
HPOG-NIE Employer survey
Semi-annual HPOG Program Performance Report
HPOG-Impact 15-month Participant Follow-Up survey

---

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	5,966	15,929	0	-9,963	0	0
Annual Time Burden (Hours)	6,292	8,212	0	-1,920	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This evaluation involves new and continuing data collection that increases the public reporting burden under this OMB number. Some data collection previously approved under this OMB number has been completed, which accounts for any decrease in burden.

---

Annual Cost to Federal Government: $4,630,736

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]? Yes

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)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(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: 09/09/2014

---