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Agency Information Collection Activities: Proposed Collection: Comment Request

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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 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 formNumber of respondentsNumber of responses per respondentTotal responsesAverage burden per response (in hours)Total burden hours
Form 1A: General Information Worksheet1,35011,3502.02,700
Planning Grant: General Information Worksheet25012502.5625
Form 1B: BPHC Funding Request Summary1,20011,3502.02,700
Form 1C: Documents on File1,35011,3501.01,350
Form 2: Proposed Staff Profile1,35011,3502.02,700
Form 3: Income Analysis Form1,20011,2005.06,000
Form 4: Community Characteristics1,35011,3501.01,350
Health Care Plan (Competing)80018002.01,600
Health Care Plan (Non-Competing)55015501.0550
Business Plan (Competing)80018002.01,600
Business Plan (Non-Competing)55015501.0550
Form 5A: Services Provided70017001.0700
Form 5B: Sites Listing70017001.0700
Form 5C: Other Site Activities70017000.5350
Change In Scope (CIS) Site—Add Checklist70017001.0700
CIS Site—Delete Checklist70017001.0700
CIS Relocation Checklist70017001.0700
CIS Service—Add Checklist70017001.0700
CIS Service—Delete Checklist70017001.0700
Add New Target Population501501.050
Form 6A: Board Member Characteristics1,35011,3501.01,350
Form 6B: Request for Waiver of Governance Requirements15011501.0150
Form 8: Health Center Affiliation Certification25012501.0250
Form 9: Need for Assistance40014003.01,200
Form 10: Emergency Preparedness Form1,35011,3501.01,350
Form 12: Organization Points of Contact1,35011,3500.5675
EHR Readiness Checklist25012501.0250
Environmental Information and Documentation (EID)40014002.0800
Equipment List40014001.0400
Other Requirements for Sites4001400.5200
Project Work Plan40014001.0400
Summary Page4001400.5200
Verification Check List2001200.5100
Alteration/Renovation (A/R) Project cover Page40014001.0400
Proposal Cover Page40014001.0400
Consolidated Budget4001400.5200
Consolidated Funding Sources40014001.0400
Project Qualification Criteria40014001.0400
Project Cover Page4001400.5200
Other Project Document40014001.0400
Funding Sources4001400.5200
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Submit your comments to 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.

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Dated: April 26, 2013.

Bahar Niakan,

Director, Division of Policy and Information Coordination.

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[FR Doc. 2013-10377 Filed 5-1-13; 8:45 am]