Providing Primary Care and Preventive Medical Services in Ryan White Funded Medical Care Settings

Forms and Documents

Document Name	Status
Form 1 Providing Primary Care and Preventive Medical Services in Ryan White Funded Medical Care Settings Form and Instruction	New
PIA HAB55_C_3440 updated2.pdf Supplementary Document	2016-03-31
H_Study Timeline.docx Supplementary Document	2015-09-09
G_Analysis Plan.docx Supplementary Document	2015-09-09
F_IRB Exemption Memo.doc Supplementary Document	2015-09-09
Supporting Statement Part B Final.docx Supporting Statement B	2015-09-09
FFFINALHABRyanWhiteSupportingStatement_Response to OMB Comment 3-24-2016.docx Supporting Statement A	2016-03-31

IC Document Collections

IC ID	Document Title	Status
218134	Providing Primary Care and Preventive Medical Services in Ryan White Funded Medical Care Settings Form and Instruction	New

ICR Details

OMB Control No: 0906-0018	ICR Reference No: 201509-0906-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Providing Primary Care and Preventive Medical Services in Ryan White Funded Medical Care Settings
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/01/2016
	Date Received in OIRA: 09/10/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2019	36 Months From Approved
Responses	280	0	0
Time Burden (Hours)	245	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This study will provide HRSA HIV/AIDS Bureau (HAB) with a better understanding of how Ryan White-funded clinics provide primary and preventative care to people living with HIV/AIDs and specifically provide background in making informed policies and changes to the Ryan White Program. Respondents in this study will include clinic directors, medical directors, clinicians, and IT/data staff.

---

Authorizing Statute(s): PL: Pub.L. 11 - 87 0 Name of Law: Ryan White HIv/AIDS Treatment Extension Act of 2009
  

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 69	04/10/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 172	09/04/2015
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Providing Primary Care and Preventive Medical Services in Ryan White Funded Medical Care Settings	2, 3, 4, 1	Clinic Director Survey ,   Clinical Survey ,   Primary Care Data Extraction Template ,   Medical Director Interview Guide

---

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	280	0	0	280	0	0
Annual Time Burden (Hours)	245	0	0	245	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: No burden increase over existing burden as this is a new package.

---

Annual Cost to Federal Government: $324,912

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]? 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? 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: 09/10/2015

---