OPRE Evaluation - National and Tribal Evaluation of the 2nd Generation of the Health Profession Opportunity Grants [descriptive evaluation, impact evaluation, cost-benefit analysis study, pilot study]

Forms and Documents

Document Name	Status
OMB#0970-0462_NonSubstantive Change Request _June 2020.docx Justification for No Material/Nonsubstantive Change	2020-06-24
Attachment J_Interview Verbal Informed Consent Form_Remote.docx Supplementary Document	2020-06-24
Attachment I_Focus Group Informed Consent Form_Remote.docx Supplementary Document	2020-06-24
Attachment B3_Tribal Evaluation Informed Consent Form B (Unique Identifiers).docx Supplementary Document	2020-06-24
Attachment B2_Tribal Evaluation Informed Consent Form A (SSNs).docx Supplementary Document	2020-06-24
Attachment B. National Evaluation Informed Consent Forms A_Lottery Required_REV.docx Supplementary Document	2020-06-24
OMB#0970-0462_NonSub Change Request_Temporary Use of Verbal Consent Forms_04152020.docx Justification for No Material/Nonsubstantive Change	2020-04-16
Attachment B3_Tribal Evaluation informed consent Form D Unique Identifiers_Verbal.docx Supplementary Document	2020-06-24
Attachment B2_Tribal Evaluation_informed consent Form C SSNs_Verbal.docx Supplementary Document	2020-06-24
Attachment B_National Evaluation informed consent Form D_ lottery not required-Verbal.docx Supplementary Document	2020-04-16
Attachment B. National Evaluation Informed Consent Form C Lottery Required _Verbal_REV.docx Supplementary Document	2020-06-24
Attachment Z_ Participant Interview Recruitment Materials.docx Supplementary Document	2019-04-18
Attachment Y 60-Day Federal Register Notice.pdf Supplementary Document	2019-04-18
Attachment X_Complete List of Previously Approved Instruments for HPOG 2.0.docx Supplementary Document	2019-04-18
Attachment W_HPOG 2.0_phone based Skills Assessment Pilot_Recruitment Script.docx Supplementary Document	2019-04-18
Attachment V_HPOG 2.0_phone based Skills Assessment Pilot_ParticipantLetter.docx Supplementary Document	2019-04-18
Attachment U_HPOG 2.0_phone based Skills Assessment Pilot_Grantee Letter.docx Supplementary Document	2019-04-18
Attachment T_HPOG 2.0_phone based Skills Assessment Pilot_Recruitment Flyer.docx Supplementary Document	2019-04-18
Attachment S_HPOG 2.0_Intermediate Follow-up Email Reminder_REV.docx Supplementary Document	2020-06-24
Attachment R_HPOG 2.0_Intermediate Follow-upSurvey_Flyer.docx Supplementary Document	2019-04-18
Attachment Q_HPOG 2.0 Intermediate Follow-up Survey Sources_REV.docx Supplementary Document	2020-06-24
Attachment P_HPOG 2.0_Intermediate Follow-up Survey Advance Letter_REV.docx Supplementary Document	2020-06-24
Attachment O_ResearchQuestions for Previously Approved National and Tribal Evaluation Efforts.docx Supplementary Document	2018-02-01
Attachment N_HPOG2.0_Short-Term Followup Short-Term Survey_ Email Remind_revised_010918_clean.docx Supplementary Document	2018-02-01
Attachment M_HPOG 2.0_Short-Term Survey Flyer 01092018.docx Supplementary Document	2018-02-01
Attachment L_HPOG 2.0 Short-Term Followup Followup Survey Sources_Rev_121217_Clean.docx Supplementary Document	2018-02-01
Attachment K_HPOG2.0_Short-Term Followup Survey Advance Letter_Rev_01092018_Clean.docx Supplementary Document	2018-02-01
Attachment K_HPOG 2 0 Incentive Communications_Email and Letter_071117 CLEAN.docx Supplementary Document	2017-07-12
Attachment J_Interview Verbal Informed Consent Form.docx Supplementary Document	2020-06-24
Attachment I_Focus Group Informed Consent Form.docx Supplementary Document	2020-06-24
Attachment H_HPOG- Model.pptx Supplementary Document	2016-10-24
Attachment A_References_Revised 09 02 16.docx Supplementary Document	2016-10-24
Attachment G. Contact Update Letter and Form.docx Supplementary Document	2015-05-11
HPOG 2.0 Supporting Statement B_Revised_NonSubChange_June 2020.docx Supporting Statement B	2020-06-24
HPOG 2.0_Supporting Statement A_Revised_NonSubChange June 2020.docx Supporting Statement A	2020-06-24
Attachment F. First Round of HPOG Grantees Ressearch Portfolio_4.28.15.docx Supplementary Document	2015-05-06
FINAL updated Attachment E PPR Data List and Mockup 8 4 15 clean.docx Supplementary Document	2015-08-05
Attachment D. Sources and Justification_5.4.15.docx Supplementary Document	2015-05-06
Attachment C_HPOG 2.0 15 mos follow up - 60 Day FRN_8.30.17.pdf Supplementary Document	2018-02-01

IC Document Collections

IC ID	Document Title	Status
242412	Instrument 18a: Intermediate Follow-up Survey for the National Evaluation impact study - Critical Items Only Other-Survey	New
235782	Instrument 20: Program cost survey Other-Survey	Removed
235781	Instrument 19: Phone-based Skills Assessment Pilot Instrument Other-Phone-based Assessment	Removed
235780	Instrument 18: Intermediate Follow-up Survey for the National Evaluation impact study Other-Survey	Modified
235779	Instrument 17: Participant interview guide Other-Interview Guide	Removed
235778	Instrument 16: Partner interview guide for the systems study Other-Interview Guide	Removed
235777	Instrument 15: Program operator interview guide for the systems study Other-Interview Guide	Removed
235776	Instrument 14: Second round telephone interview protocol for non-tribal HPOG grantee staff and partners Other-Interview Guide	Removed
235775	Instrument 13: Screening tool for identifying respondents for second-round telephone interviews Other-Screener	Removed
229940	Instrument 12: Short-Term Follow-up Survey for the HPOG 2.0 National Evaluation Impact Evaluation Other-Survey	Removed
229938	Instrument 5b: HPOG 2.0 National Evaluation letter and participant contact update form Other-Update Form	Modified
224119	Instrument 11: HPOG 2.0 Tribal Evaluation program participant non-completer interviews Other-Interview	Unchanged
224118	Instrument 10: HPOG 2.0 Tribal Evaluation program participant completer interviews Other-Interview	Unchanged
224113	Instrument 9: HPOG 2.0 Tribal Evaluation program participant focus groups Other-Focus Group	Unchanged
224112	Instrument 8: HPOG 2.0 Tribal Evaluation employer interviews Other-Interview	Unchanged
224110	Instrument 7: HPOG 2.0 Tribal Evaluation program implementation staff interviews Other-Interview	Unchanged
224107	Instrument 6: HPOG 2.0 Tribal Evaluation grantee and partner administrative staff interviews Other-Interview	Unchanged
216432	PAGES Participant-Level Baseline Data Collection (participants at Tribal grantees) Other-Data collection System	Unchanged
216431	PAGES Participant-Level Baseline Data Collection (participants at non-Tribal grantees participating in impact study) Other-Data collection System	Modified
216430	PAGES Grantee- and Participant-Level Data Collection (all grantees) Other-Data collection System	Unchanged

ICR Details

OMB Control No: 0970-0462	ICR Reference No: 202006-0970-008
Status: Historical Active	Previous ICR Reference No: 202004-0970-009
Agency/Subagency: HHS/ACF	Agency Tracking No: OPRE
Title: OPRE Evaluation - National and Tribal Evaluation of the 2nd Generation of the Health Profession Opportunity Grants [descriptive evaluation, impact evaluation, cost-benefit analysis study, pilot study]
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/29/2020
	Date Received in OIRA: 06/24/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2022	07/31/2022	07/31/2022
Responses	22,696	0	21,040
Time Burden (Hours)	8,151	0	9,780
Cost Burden (Dollars)	0	0	0

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Abstract: Between August 2015 and July 2019, OMB has approved several information collection instruments, procedures and supporting materials in support HPOG 2.0. These include baseline data collection from HPOG 2.0 National and Tribal Evaluation study participants, data collection protocols and procedures for the HPOG 2.0 Tribal Evaluation, a Short-term Follow-up Survey as part of the National Evaluation’s impact study, and several instruments in support of the National Evaluation, including a phone-based skills assessment pilot instrument and an Intermediate Follow-up Survey to support the HPOG 2.0 National Evaluation impact study. ACF requests approval of non-substantive changes to several of the previously approved information collections and supporting materials. These requested changes are based primarily on three events: (1) ACF’s decision to extend the HPOG Program grants by twelve months, ending in September 2021 instead of September 2020; (2) the National Evaluation team’s experiences completing data collection for the Short-Term Follow-up Survey (Instrument 12) and the results of the Phone-based Skills Assessment Pilot (Instrument 19); and (3) the COVID-19 pandemic and associated travel restrictions.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 5507 , sec. 2008, (a)(3)(B) Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 66715	12/27/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 16870	04/23/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 12

IC Title	Form No.	Form Name
Instrument 20: Program cost survey
Instrument 18: Intermediate Follow-up Survey for the National Evaluation impact study
Instrument 9: HPOG 2.0 Tribal Evaluation program participant focus groups
Instrument 6: HPOG 2.0 Tribal Evaluation grantee and partner administrative staff interviews
Instrument 7: HPOG 2.0 Tribal Evaluation program implementation staff interviews
Instrument 8: HPOG 2.0 Tribal Evaluation employer interviews
Instrument 10: HPOG 2.0 Tribal Evaluation program participant completer interviews
Instrument 11: HPOG 2.0 Tribal Evaluation program participant non-completer interviews
PAGES Participant-Level Baseline Data Collection (participants at non-Tribal grantees participating in impact study)
PAGES Grantee- and Participant-Level Data Collection (all grantees)
PAGES Participant-Level Baseline Data Collection (participants at Tribal grantees)
Instrument 5b: HPOG 2.0 National Evaluation letter and participant contact update form
Instrument 12: Short-Term Follow-up Survey for the HPOG 2.0 National Evaluation Impact Evaluation
Instrument 13: Screening tool for identifying respondents for second-round telephone interviews
Instrument 14: Second round telephone interview protocol for non-tribal HPOG grantee staff and partners
Instrument 15: Program operator interview guide for the systems study
Instrument 16: Partner interview guide for the systems study
Instrument 19: Phone-based Skills Assessment Pilot Instrument
Instrument 18a: Intermediate Follow-up Survey for the National Evaluation impact study - Critical Items Only
Instrument 17: Participant interview guide

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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	22,696	21,040	0	394	1,262	0
Annual Time Burden (Hours)	8,151	9,780	0	-2,790	1,161	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 change request includes increasing the number of respondents to Instrument 1 PAGES Participant-Level Baseline Data Collection (for participants at non-tribal grantees). Additionally, we took the opportunity to update the information collections and remove ICs that are complete and no longer in use.

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Annual Cost to Federal Government: $4,717,923

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? Yes

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Common Form ICR:  No

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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: 06/24/2020

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