National Hospital Organ Donation Campaign's Activity Scorecard

ICR 201905-0915-003

OMB: 0915-0373

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2019-12-18
IC Document Collections
IC ID
Document
Title
Status
209057 Modified
ICR Details
0915-0373 201905-0915-003
Historical Active 201809-0915-002
HHS/HSA 20741
National Hospital Organ Donation Campaign's Activity Scorecard
Revision of a currently approved collection   No
Regular
Approved with change 12/19/2019
Retrieve Notice of Action (NOA) 10/10/2019
  Inventory as of this Action Requested Previously Approved
12/31/2022 36 Months From Approved 03/31/2020
1,500 0 1,250
375 0 459
0 0 0

The Hospital Campaign Scorecard was developed to: 1) motivate and assist healthcare organizations in conducting activities that promote organ, eye, and tissue donor registration by providing a turn-key menu of outreach strategies; 2) provide a basis for recognition by government and national partners; and, 3) measure and evaluate campaign process and outcomes.

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

Not associated with rulemaking

  84 FR 31602 07/02/2019
84 FR 54616 10/10/2019
No

1
IC Title Form No. Form Name
Hospital Campaign Activity Scorecard 1 HC Scorecard 2020.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 1,500 1,250 0 250 0 0
Annual Time Burden (Hours) 375 459 0 -84 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
the burden was retested and found to take only .25 hours vs. .37 from 2017.

$24,310
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.
10/10/2019


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