Pregnancy Assistance Fund Feasibility And Design Study(Positive Adolescent Futures)

Forms and Documents

Document Name	Status
0990-0424Attachment G_PAF Follow up Pretest Memorandum.docx Supplementary Document	2016-01-06
0990-0424 Attachment E_Confidentiality Pledge PAF FU.pdf Supplementary Document	2016-01-06
0990-0424Attachment C_Sources Referenced for PAF Follow Up.docx Supplementary Document	2016-01-06
0990-0424Attachment D_Persons Consulted.docx Supplementary Document	2016-01-06
0990-0424Attachment F_PAF Analysis Plan for Impact Study_FU.docx Supplementary Document	2016-01-06
0990-0424 PAF FU Supporting Statement B_OMB comments_Passback Clean.docx Supporting Statement B	2016-01-06
0990-0424 PAF FU Supporting Statement A OMB comments_Passback Clean.docx Supporting Statement A	2016-01-06
0990-Attachment J_PAF_Consent Letters and Forms and Youth Assent Form_08262014.docx Supplementary Document	2014-08-29
0990-SupplementalDoc_Attachment B_Email Template for Interview.docx Supplementary Document	2014-06-25
0990-SupplementDoc_Attachment A_Overview of PAF Evaluation.docx Supplementary Document	2014-06-25

IC Document Collections

IC ID	Document Title	Status
212904	12 Month follow-up survey of impact study participants Other-survey	Modified
212078	Baseline Survey of impact study participants Other-Plan	Modified
212077	Grantee Interview Protocol Other-guide	Modified

ICR Details

OMB Control No: 0990-0424	ICR Reference No: 201601-0990-001
Status: Historical Active	Previous ICR Reference No: 201505-0990-001
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Pregnancy Assistance Fund Feasibility And Design Study(Positive Adolescent Futures)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/07/2016
	Date Received in OIRA: 01/06/2016
Terms of Clearance: Results of the three separate program evaluations contained within this collection are not intended to be generalized to the broader Pregnancy Assistance Fund grantee national network. Upon publication and communication of this collection's outcomes, the Agency will clearly describe the research limitations and specific scope of this collection.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2019	36 Months From Approved	08/31/2017
Responses	1,251	0	957
Time Burden (Hours)	683	0	487
Cost Burden (Dollars)	0	0	0

---

Abstract: The objective of the Pregnancy Assistance Fund (PAF) Feasibility and Design Study (FADS) is to establish a foundation for a rigorous impact and implementation evaluation. Specifically, FADS will: (1) assess design options for implementation and impact evaluation, (2) document how PAF programs are operationalized in the field, (3) identify and enter into agreements with two or three sites for the evaluation, (4) provide assistance to sites to support a rigorous evaluation framework, (5) develop all evaluation instruments and obtain clearance, and (6) pilot baseline data collection. As described below, the evaluation will have two main components: the Design and Implementation Analysis and the Impact Study.

---

Authorizing Statute(s): PL: Pub.L. 111 - 148 10211-10214 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:
	80 FR 26281	05/07/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 43099	07/21/2015
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Baseline Survey of impact study participants
12 Month follow-up survey of impact study participants
Grantee Interview Protocol

---

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	1,251	957	0	1,250	-956	0
Annual Time Burden (Hours)	683	487	0	683	-487	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: OMB gave approval on August 30, 2014, for the PAF baseline survey and telephone interviews across 17 Pregnancy Assistance Fund grantees (OMB Control # 0990-0424). We now seek a revision to the existing approval to add the data collection associated with the 12-month follow-up survey instruments. This request is an adjustment increasing the total burden from 349 hours to 682.67 hours.

---

Annual Cost to Federal Government: $561,645

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: 01/06/2016

---