Evaluation of the 2009 CHIPRA Quality Demonstration Grant Program: Survey Data Collection

Forms and Documents

Document Name	Status
Form Form #1 Pediatrician and Family Physicians Survey Form and Instruction	New
SS Part B -- Evaluation of the 2009 CHIPRA Quality Demonstration Grant Program -- Survey Data Collection 8-22-2013.docx Supporting Statement B	2013-08-22
Attachment G - Confidentiality Pledge.docx Supplementary Document	2013-08-22
Attachment F -- Federal Register Notice.pdf Supplementary Document	2013-08-22
Attachment A - Authorizing Legislation.docx Supplementary Document	2013-08-22
Attachment E- CHIPRA physician survey reminder letter.docx Supplementary Document	2013-08-22
Attachment C -CHIPRA physician survey advance and cover letters.docx Supplementary Document	2013-08-22
Attachment D - CHIPRA_reminder postcard.docx Supplementary Document	2013-08-22
SS Part A -- Evaluation of the 2009 CHIPRA Quality Demonstration Grant Program -- Survey Data Collection 8-22-2013.docx Supporting Statement A	2013-08-22

IC Document Collections

IC ID	Document Title	Status
208374	Pediatrician and Family Physicians Survey Form and Instruction	New

ICR Details

OMB Control No: 0935-0215	ICR Reference No: 201308-0935-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No: 20356
Title: Evaluation of the 2009 CHIPRA Quality Demonstration Grant Program: Survey Data Collection
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 without change	Conclusion Date: 09/26/2013
	Date Received in OIRA: 08/26/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2015	18 Months From Approved
Responses	1,200	0	0
Time Burden (Hours)	300	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 401(a) of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Pub. L. 111-3, amended the Social Security Act (the Act) to enact section 1139A (42 U.S.C. 1320b-9a). AHRQ is requesting approval from the Office of Management and Budget (OMB) for the collection of quantitative data through a survey of pediatricians and family medicine physicians to support a comprehensive, mixed-methods evaluation of the quality demonstration grants authorized under section 1139A(d) of the Act (Attachment A). AHRQ's mission of improving the quality and effectiveness of health care in the United States aligns with evaluating whether, and through what mechanism, projects funded by the CHIPRA demonstration grants improve the quality of care received by children in Medicaid and the Children's Health Insurance Program (CHIP).

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
  

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:
	78 FR 32652	05/31/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 49516	08/14/2013
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Pediatrician and Family Physicians Survey	Form #1	Pediatrician and Family Physician Survey

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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	1,200	0	0	1,200	0	0
Annual Time Burden (Hours)	300	0	0	300	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: This is a new information collection request.

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Annual Cost to Federal Government: $152,983

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

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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: 08/26/2013

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