Agency Information Collection Activities: Proposed Collection: Public Comment Request; Information Collection Request Title: Health Center Program Forms OMB No. 0915-0285 Revision

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Published

October 17, 2022

Issuing agencies

Health and Human Services DepartmentHealth Resources and Services Administration

Abstract

In compliance with the requirement for opportunity for public comment on proposed data collection projects of the Paperwork Reduction Act of 1995, HRSA announces plans to submit an Information Collection Request (ICR), described below, to the Office of Management and Budget (OMB). Prior to submitting the ICR to OMB, HRSA seeks comments from the public regarding the burden estimate, below, or any other aspect of the ICR.

Full Text

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<title>Federal Register, Volume 87 Issue 199 (Monday, October 17, 2022)</title>
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[Federal Register Volume 87, Number 199 (Monday, October 17, 2022)]
[Notices]
[Pages 62861-62863]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-22510]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration

Agency Information Collection Activities: Proposed Collection:
Public Comment Request; Information Collection Request Title: Health
Center Program Forms OMB No. 0915-0285 Revision

AGENCY: Health Resources and Services Administration (HRSA), Department
of Health and Human Services.

ACTION: Notice.

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SUMMARY: In compliance with the requirement for opportunity for public
comment on proposed data collection projects of the Paperwork Reduction
Act of 1995, HRSA announces plans to submit an Information Collection
Request (ICR), described below, to the Office of Management and Budget
(OMB). Prior to submitting the ICR to OMB, HRSA seeks comments from the
public regarding the burden estimate, below, or any other aspect of the
ICR.

DATES: Comments on this ICR should be received no later than December
16, 2022.

ADDRESSES: Submit your comments to <a href="/cdn-cgi/l/email-protection#4d3d2c3d283f3a223f260d253f3e2c632a223b"><span class="__cf_email__" data-cfemail="2757465742555048554c674f55544609404851">[email&#160;protected]</span></a> or mail the HRSA
Information Collection Clearance Officer, Room 14N136B, 5600 Fishers
Lane, Rockville, MD 20857.

FOR FURTHER INFORMATION CONTACT: To request more information on the
proposed project or to obtain a copy of the data collection plans and
draft instruments, email <a href="/cdn-cgi/l/email-protection#f686978693848199849db69e848597d8919980"><span class="__cf_email__" data-cfemail="413120312433362e332a01293332206f262e37">[email&#160;protected]</span></a> or call Samantha Miller,
the acting HRSA Information Collection Clearance Officer at (301) 443-
9094.

SUPPLEMENTARY INFORMATION: When submitting comments or requesting
information, please include the information request collection title
for reference.
Information Collection Request Title: Health Center Program Forms,
OMB No. 0915-0285 Revision.
Abstract: The Health Center Program, administered by HRSA, is
authorized under section 330 of the Public Health Service (PHS) Act (42
U.S.C. 254b). Health centers are community-based and patient-directed
organizations that deliver affordable, accessible, quality, and cost-
effective primary health care services to patients regardless of their
ability to pay. Nearly 1,400 health centers operate approximately
14,000 service delivery sites that provide primary health care to more
than 30 million people in every U.S. state, the District of Columbia,
Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin. HRSA uses
forms for new and existing health centers and other entities to apply
for various grant and non-grant opportunities, renew grant and non-
grant designations, report progress, and change their scopes of
project.
Need and Proposed Use of the Information: Health Center Program-
specific forms are necessary for award processes and oversight of the
Health Center Program and other relevant programs. These forms provide
HRSA staff and objective review committee panels with information
essential for application evaluation, funding recommendation and
approval, designation, and monitoring. These forms also provide HRSA
staff with information essential for evaluating compliance with Health
Center Program statutory and regulatory requirements.

[[Page 62862]]

HRSA intends to make several changes to its forms:
<bullet> HRSA will modify the following forms to streamline and
clarify data currently being collected: 1A, 1B, 1C, 2, 4, 6A, 8,
Checklist for Adding a New Service, Checklist for Adding a New Service
Delivery Site, Checklist for Adding a New Target Population, Checklist
for Deleting Existing Service, Checklist for Deleting Existing Service
Delivery Site, Expanded Services Patient Impact, Health Center
Controlled Networks Progress Report, Native Hawaiian Health Care
Improvement Act (NHHCIA) Non-Competing Continuation (NCC) Clinical and
Financial Performance Measures, NHHCIA NCC Income Analysis Form, NHHCIA
NCC Project Work Plan Progress Report, NHHCIA NCC Project Work Plan
Update, Operational Plan, Project Narrative Update, Project Overview
Form, Project Work Plan, and the Summary Page--Service Area
Competition.
<bullet> HRSA will add forms necessary for funding applications and
program monitoring: Applicant Qualification Criteria Form, Financial
Performance Indicators, Funding Request Summary Form, fiscal year (FY)
2022 Accelerating Cancer Screening Progress Report, Patient Impact
Form, Project Cover Page, Progress Report--Non-Capital Investments,
School-Based Health Center Location Form, Quality Improvement Fund
(QIF) Evaluative Measures Report, QIF Project Plan Form and QIF
Progress Report.
<bullet> HRSA will remove forms to further streamline information
collected by HRSA and reduce burden: Clinical Performance Measures,
Diabetes Action Plan, Expanded Services, Financial Performance
Measures, FY 2018 Expanding Access to Quality Substance Use Disorder--
Mental Health Integrated Behavioral Health Services Progress Reporting,
Health Center Program Supplemental Information, HRSA Electronic
Handbooks Action Plan, and the Program Specific Form Instructions.
Likely Respondents: Health Center Program award recipients (those
funded under section 330 of the PHS Act) and Health Center Program
look-alikes, state and national technical assistance organizations, and
other organizations seeking funding.
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 ICR are summarized in the table below.
Total Estimated Annualized Burden--Hours:

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Number of Average burden
Form name Number of responses per Total per response Total burden
respondents respondent responses (in hours) hours
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Applicant Qualification Criteria 500 1 500 1.00 500
Form...........................
Capital Semi Annual Progress 1,317 2 2,634 1.00 2,634
Report.........................
Checklist for Adding a New 450 1 450 2.00 900
Service........................
Checklist for Adding a New 1,480 1 1,480 2.00 2,960
Service Delivery Site..........
Checklist for Adding a New 100 1 100 2.00 200
Target Population..............
Checklist for Deleting Existing 500 1 500 2.00 1,000
Service........................
Checklist for Deleting Existing 750 1 750 2.00 1,500
Service Delivery Site..........
Environmental Information and 750 1 750 0.50 375
Documentation..................
Equipment List.................. 1,375 1 1,375 0.50 688
Expanded Services Patient Impact 996 1 996 1.00 996
Federal Object Class Categories 735 1 735 0.25 184
Form...........................
Financial Performance Indicators 20 1 20 1.00 20
Form 12: Organization Contacts.. 1,058 1 1,058 1.00 1,058
Form 1A: General Information 1,058 1 1,058 1.00 1,058
Worksheet......................
Form 1B: Funding Request Summary 1,000 1 1,000 0.75 750
Form 1C: Documents on File...... 1,058 1 1,058 0.50 529
Form 2: Staffing Profile........ 1,058 1 1,058 1.00 1,058
Form 3: Income Analysis......... 1,058 1 1,058 1.00 1,058
Form 3A: Look-Alike Budget 50 1 50 1.00 50
Information....................
Form 4: Community 1,058 1 1,058 1.00 1,058
Characteristics................
Form 5A: Services Provided...... 1,058 1 1,058 1.00 1,058
Form 5B: Service Sites.......... 1,058 1 1,058 1.00 1,058
Form 5C: Other Activities/ 1,058 1 1,058 1.00 1,058
Locations......................
Form 6A: Current Board Member 1,058 1 1,058 1.00 1,058
Characteristics................
Form 6B: Request for Waiver of 1,058 1 1,058 1.00 1,058
Board Member Requirements......
Form 8: Health Center Agreements 1,058 1 1,058 1.00 1,058
Funding Request Summary Form 500 1 500 0.50 250
School-Based Health Center.....
Funding Sources................. 735 1 735 0.50 368
FY2020 Ending the HIV Epidemic 182 1 182 1.00 182
Primary Care HIV Prevention
PCHP Progress Reporting........
FY2022 Accelerating Cancer 10 1 10 1.50 15
Screening Progress Report......
Health Center Controlled 90 1 90 1.00 90
Networks Progress Report.......
Health Center Program Progress 735 1 735 1.00 735
Report.........................
HRSA Loan Guarantee Program 20 1 20 1.00 20
Application....................
NHHCIA NCC Clinical Performance 6 1 6 1.50 9
Measures.......................
NHHCIA NCC Financial Performance 6 1 6 0.50 3
Measures.......................
NHHCIA NCC Income Analysis Form. 6 1 6 0.15 1
NHHCIA NCC Project Work Plan 6 1 6 0.15 1
Progress Report................

[[Page 62863]]

NHHCIA NCC Project Work Plan 6 1 6 0.15 1
Update.........................
Operational Plan................ 500 1 500 3.00 1,500
Other Requirements for Sites.... 600 1 600 0.50 300
Participating Health Centers 90 1 90 1.00 90
List...........................
Patient Impact Form............. 500 1 500 1.00 500
Patient Target and Calculations. 1,058 1 1,058 1.00 1,058
Progress Report--Non-Capital 1,400 4 5,600 1.50 8,400
Investments....................
Project Cover Page.............. 735 1 735 1.00 735
Project Narrative Update........ 883 1 883 4.00 3,532
Project Overview Form........... 182 1 182 1.00 182
Project Plan.................... 182 3 546 1.50 819
Project Qualification Criteria.. 735 1 735 1.00 735
Project Work Plan............... 135 1 135 4.00 540
Proposal Cover Page............. 735 1 735 1.00 735
QIF Evaluative Measures Report.. 12 1 12 1.50 18
QIF Progress Report............. 12 1 12 1.50 18
QIF Project Plan Form........... 100 1 100 1.00 100
Summary Page (New Access Point- 500 1 500 1.00 500
Funding Type)..................
Summary Page Service Area 450 1 450 0.50 225
Competition....................
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Total....................... 33,830 .............. 39,711 .............. 46,586
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HRSA specifically requests comments on (1) the necessity and
utility of the proposed information collection for the proper
performance of the agency's functions, (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.

Maria G. Button,
Director, Executive Secretariat.
[FR Doc. 2022-22510 Filed 10-14-22; 8:45 am]
BILLING CODE 4165-15-P

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