National Learning Community for HIV CBO Leadership Evaluation

Forms and Documents

Document Name	Status
Form 0920- Semi-Structured Interview Form	New
Form 0920- Post-Participation Survey Form	New
Form 0920- Registration Form Form	New
Att 16_Project Determination.docx Supplementary Document	2021-11-03
Att 15_Security Controls.docx Supplementary Document	2021-11-03
Att 1_Auth Legislation.docx Supplementary Document	2021-11-03
SSB_v2_102721.docx Supporting Statement B	2021-11-03
SSA.v2_102821.docx Supporting Statement A	2021-11-03

IC Document Collections

IC ID	Document Title	Status
250072	Semi-Structured Interview Form	New
250070	Post-Participation Survey Form	New
250068	Registration Form Form	New

ICR Details

OMB Control No:	ICR Reference No: 202110-0920-015
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-21EL
Title: National Learning Community for HIV CBO Leadership Evaluation
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 11/30/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	675	0
Time Burden (Hours)	89	0
Cost Burden (Dollars)	0	0

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Abstract: CDC will assess the National Learning Community’s usefulness of training materials used by mid- and senior-level Community Based Organization (CBO) leaders’ management of people, programs, and organizations. Applying the Kirkpatrick four-level of training evaluation we are focused on getting National Learning Community participants reactions to the overall training gaining insight to whether the training fulfilled learning objectives and insight to the learners’ experience. We are also focus on two other levels of the Kirkpatrick evaluation model in which we are seeking information to determine if we built skills and knowledge during the training, and for those who complete the intensive if they are able to apply their new knowledge/skills to their work.

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Authorizing Statute(s): US Code: 42 USC Section 301-792[295k] (a) Name of Law: Public Health Service 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:
	86 FR 22053	04/26/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 66807	11/22/2021
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Post-Participation Survey	0920-	National Learning Community for HIV CBO Leadership Post-Participation Survey
Registration Form	0920-	National Learning Community for HIV CBO Leadership Registration Form
Semi-Structured Interview	0920-	National Learning Community for HIV CBO Leadership Semi-Structured Interview

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ICR Summary of Burden

	Total Request	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	675	0	0	675	0	0
Annual Time Burden (Hours)	89	0	0	89	0	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: NEW collection request for a new OMB Control Number.

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Annual Cost to Federal Government: $4,501

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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.     No

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.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

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? No

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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: 11/30/2021

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