Title X Substainability Assessment Tool For Grantees and Service Sites

ICR 201501-0990-003

OMB: 0990-0442

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
0990-0442 201501-0990-003
Historical Active
HHS/HHSDM
Title X Substainability Assessment Tool For Grantees and Service Sites
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 12/22/2015
Retrieve Notice of Action (NOA) 06/18/2015
This collection is approved for 3 years with the determination that OPA will not use collected data to make funding decisions, but will utilize it to assess the need for additional resources to improve the sustainability of the Title X network.
  Inventory as of this Action Requested Previously Approved
12/31/2018 36 Months From Approved
4,260 0 0
2,812 0 0
0 0 0

The Office of Population Affairs within the Office of the Assistant Secretary for Health seeks to collect data from the Title X centers on efforts related to (1) assisting individuals in obtaining health insurance; (2) partnerships with primary care providers; (3) availability and use of electronic health records; (4) monitoring patient care quality; (5) factors affecting revenue sources; and (6) the way that sites conduct analyses to consider the cost of providing services.

US Code: 42 USC 300 Name of Law: Title X of the Public Health Service Act
   PL: Pub.L. 111 - 148 4207 Name of Law: Patient Protection of the Affordable Care Act
   PL: Pub.L. 91 - 572 1001 Name of Law: Title X of the Public Health Service Act
  
None

Not associated with rulemaking

  80 FR 3593 01/23/2015
80 FR 34683 06/17/2015
No

2
IC Title Form No. Form Name
Sustainability Assessment Sites
Sustainability Assessment Grantees

  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 4,260 0 0 4,260 0 0
Annual Time Burden (Hours) 2,812 0 0 2,812 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
New collection

$8,000
Yes Part B of Supporting Statement
No
Yes
No
No
Uncollected
Sherrette Funn-Coleman 2026905683

  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.
06/18/2015


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