This PDF is the current document as it appeared on Public Inspection on 05/01/2013 at 08:45 am.
In compliance with the requirement for opportunity for public comment on proposed data collection projects (Section 3506(c)(2)(A) of Title 44, United States Code, as amended by the Paperwork Reduction Act of 1995, Pub. L. 104-13), the Health Resources and Services Administration (HRSA) publishes periodic summaries of proposed projects being developed for submission to the Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995. To request more information on the proposed project or to obtain a copy of the data collection plans and draft instruments, email firstname.lastname@example.org or call the HRSA Reports Clearance Officer at (301) 443-1984.
HRSA especially requests comments on: (1) The necessity and utility of the proposed information collection for the proper performance of the agency's Start Printed Page 25751functions, (2) the accuracy of the estimated burden, (3) ways to enhance the quality, utility, and clarity of the information to be collected, and (4) the use of automated collection techniques or other forms of information technology to minimize the information collection burden.
Information Collection Request Title: Health Center Program Application Forms: (OMB No. 0915-0285 Revision).
Abstract: Health centers (section 330 grant funded and Federally Qualified Health Center Look-Alikes) deliver comprehensive, high quality, cost-effective primary health care to patients regardless of their ability to pay. Health centers have become an essential primary care provider for America's most vulnerable populations. Health centers advance the preventive and primary medical/health care home model of coordinated, comprehensive, and patient-centered care, coordinating a wide range of medical, dental, behavioral, and social services. More than 1,200 health centers operate nearly 9,000 service delivery sites that provide care in every state, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin.
The Health Centers Program is administered by HRSA's Bureau of Primary Health Care (BPHC). HRSA/BPHC uses the following application forms to oversee the Health Center Program. These application forms are used by new and existing Health centers to apply for various grant and non-grant opportunities, renew their grant or non-grant designation, and change their scope of project.
Burden Statement: Burden in this context means the time expended by persons to generate, maintain, retain, disclose or provide the information requested. This includes the time needed to review instructions, to develop, acquire, install and utilize technology and systems for the purpose of collecting, validating and verifying information, processing and maintaining information, and disclosing and providing information, to train personnel and to be able to respond to a collection of information, to search data sources, to complete and review the collection of information, and to transmit or otherwise disclose the information. The total annual burden hours estimated for this Information Collection Request are summarized in the table below.
The annual estimate of burden is as follows:
|Type of application form||Number of respondents||Number of responses per respondent||Total responses||Average burden per response (in hours)||Total burden hours|
|Form 1A: General Information Worksheet||1,350||1||1,350||2.0||2,700|
|Planning Grant: General Information Worksheet||250||1||250||2.5||625|
|Form 1B: BPHC Funding Request Summary||1,200||1||1,350||2.0||2,700|
|Form 1C: Documents on File||1,350||1||1,350||1.0||1,350|
|Form 2: Proposed Staff Profile||1,350||1||1,350||2.0||2,700|
|Form 3: Income Analysis Form||1,200||1||1,200||5.0||6,000|
|Form 4: Community Characteristics||1,350||1||1,350||1.0||1,350|
|Health Care Plan (Competing)||800||1||800||2.0||1,600|
|Health Care Plan (Non-Competing)||550||1||550||1.0||550|
|Business Plan (Competing)||800||1||800||2.0||1,600|
|Business Plan (Non-Competing)||550||1||550||1.0||550|
|Form 5A: Services Provided||700||1||700||1.0||700|
|Form 5B: Sites Listing||700||1||700||1.0||700|
|Form 5C: Other Site Activities||700||1||700||0.5||350|
|Change In Scope (CIS) Site—Add Checklist||700||1||700||1.0||700|
|CIS Site—Delete Checklist||700||1||700||1.0||700|
|CIS Relocation Checklist||700||1||700||1.0||700|
|CIS Service—Add Checklist||700||1||700||1.0||700|
|CIS Service—Delete Checklist||700||1||700||1.0||700|
|Add New Target Population||50||1||50||1.0||50|
|Form 6A: Board Member Characteristics||1,350||1||1,350||1.0||1,350|
|Form 6B: Request for Waiver of Governance Requirements||150||1||150||1.0||150|
|Form 8: Health Center Affiliation Certification||250||1||250||1.0||250|
|Form 9: Need for Assistance||400||1||400||3.0||1,200|
|Form 10: Emergency Preparedness Form||1,350||1||1,350||1.0||1,350|
|Form 12: Organization Points of Contact||1,350||1||1,350||0.5||675|
|EHR Readiness Checklist||250||1||250||1.0||250|
|Environmental Information and Documentation (EID)||400||1||400||2.0||800|
|Other Requirements for Sites||400||1||400||.5||200|
|Project Work Plan||400||1||400||1.0||400|
|Verification Check List||200||1||200||.5||100|
|Alteration/Renovation (A/R) Project cover Page||400||1||400||1.0||400|
|Proposal Cover Page||400||1||400||1.0||400|
|Consolidated Funding Sources||400||1||400||1.0||400|
|Project Qualification Criteria||400||1||400||1.0||400|
|Project Cover Page||400||1||400||.5||200|
|Other Project Document||400||1||400||1.0||400|
Submit your comments to email@example.com or mail the HRSA Reports Clearance Officer, Room 10-29, Parklawn Building, 5600 Fishers Lane, Rockville, MD 20857.
Deadline: Comments on this Information Collection Request must be received within 60 days of this notice.Start Signature
Dated: April 26, 2013.
Director, Division of Policy and Information Coordination.
[FR Doc. 2013-10377 Filed 5-1-13; 8:45 am]
BILLING CODE 4165-15-P