National Hospital Organ Donation Campaign's Activity Scorecard

ICR 201809-0915-002

OMB: 0915-0373

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Justification for No Material/Nonsubstantive Change
2018-09-26
Supplementary Document
2017-01-19
Supplementary Document
2017-01-19
Supporting Statement A
2017-01-19
IC Document Collections
IC ID
Document
Title
Status
209057 Modified
ICR Details
0915-0373 201809-0915-002
Historical Active 201701-0915-006
HHS/HSA 20741
National Hospital Organ Donation Campaign's Activity Scorecard
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 10/05/2018
Retrieve Notice of Action (NOA) 09/27/2018
  Inventory as of this Action Requested Previously Approved
03/31/2020 03/31/2020 03/31/2020
1,250 0 1,250
459 0 459
0 0 0

The Hospital Campaign Activity Scorecard was developed to: 1) motivate and assist hospitals to conduct donor registration activities by providing a turn-key menu of outreach strategies to simplify and facilitate activity implementation, 2) provide a basis for reward and recognition, and 3) evaluate the Hospital Campaign efforts.

PL: Pub.L. 108 - 216 377A(a) Name of Law: ORGAN DONATION AND RECOVERY IMPROVEMENT ACT
   US Code: 42 USC 3777A(a) 274f-1 Name of Law: PHS Act
  
None

Not associated with rulemaking

  81 FR 79506 11/14/2016
82 FR 4899 01/17/2017
Yes

1
IC Title Form No. Form Name
Hospital Campaign Activity Scorecard 1, 2 FINALCleanChallengeScorecard ,   OMB Hospital Campaign Challenge Scorecard CLEAN.docx

  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 1,250 1,250 0 0 0 0
Annual Time Burden (Hours) 459 459 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$20,530
No
    No
    No
No
No
No
Uncollected
Elyana Bowman 301 443-3983 enadjem@hrsa.gov

  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.
09/27/2018


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