Notice2026-07793
Agency Information Collection Activities: Submission to OMB for Review and Approval; Public Comment Request; Health Center Program Forms-OMB No. 0915-0285-Revision
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
April 22, 2026
Issuing agencies
Health and Human Services DepartmentHealth Resources and Services Administration
Abstract
In compliance with the Paperwork Reduction Act of 1995, HRSA submitted an Information Collection Request (ICR) to the Office of Management and Budget (OMB) for review and approval. Comments submitted during the first public review of this ICR will be provided to OMB. OMB will accept further comments from the public during the review and approval period. HRSA seeks comments from the public regarding the burden estimate below or any other aspect of the ICR. OMB may act on HRSA's ICR only after the 30-day comment period for this notice has closed.
Full Text
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<title>Federal Register, Volume 91 Issue 77 (Wednesday, April 22, 2026)</title>
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[Federal Register Volume 91, Number 77 (Wednesday, April 22, 2026)]
[Notices]
[Pages 21505-21508]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-07793]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Agency Information Collection Activities: Submission to OMB for
Review and Approval; Public Comment Request; 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 Paperwork Reduction Act of 1995, HRSA
submitted an Information
[[Page 21506]]
Collection Request (ICR) to the Office of Management and Budget (OMB)
for review and approval. Comments submitted during the first public
review of this ICR will be provided to OMB. OMB will accept further
comments from the public during the review and approval period. HRSA
seeks comments from the public regarding the burden estimate below or
any other aspect of the ICR. OMB may act on HRSA's ICR only after the
30-day comment period for this notice has closed.
DATES: Comments on this ICR should be received no later than May 22,
2026.
ADDRESSES: Written comments and recommendations for the proposed
information collection should be sent within 30 days of publication of
this notice to <a href="http://www.reginfo.gov/public/do/PRAMain">www.reginfo.gov/public/do/PRAMain</a>. Find this particular
information collection by selecting ``Currently under Review--Open for
Public Comments'' or by using the search function.
FOR FURTHER INFORMATION CONTACT: To request a copy of the clearance
requests submitted to OMB for review, email Samantha Miller, the HRSA
Information Collection Clearance Officer, at <a href="/cdn-cgi/l/email-protection#dcacbdacb9aeabb3aeb79cb4aeafbdf2bbb3aa"><span class="__cf_email__" data-cfemail="e89889988d9a9f879a83a8809a9b89c68f879e">[email protected]</span></a> or call
(301) 443-3983.
SUPPLEMENTARY INFORMATION:
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 Act (42
U.S.C. 254b). Health centers are patient-directed organizations that
deliver affordable, accessible, quality, and cost-effective primary
health care services to patients and adjust fees based on income and
family size. Nearly 1,400 health centers operate more than 16,000
service delivery sites that provide primary health care to more than 32
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 scope of project.
A 60-day notice published in the Federal Register on December 15,
2025, vol. 90, No. 238; pp. 58019-21. There was one comment. The
commenter noted that tracking and managing service areas defined by
Form 5B ZIP codes is complex when a health center uses the Health
Center Program forms. In response, HRSA is currently exploring
improvements to the Health Center Program GeoCare Navigator to help
health centers better visualize their service area prior to requesting
changes to their service area.
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 merit review panels with the 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. The current forms will
expire April 30, 2026, and this input will inform edits and updates to
the Health Center Program's information collection and reporting. HRSA
intends to make several changes to its forms.
HRSA will modify the following forms to update and clarify data
currently being collected:
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Form No./name Description of modifications
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Form 1A: General Information Worksheet. Updated response options and
text; aligned classification
to the current process;
removed the visit-count field.
Form 2: Staffing Profile............... Moved to FTE counts;
standardized staffing
categories.
Form 3: Income Analysis................ Question updates with targeted
adds/removals.
Form 5A: Services Provided............. Updated labels and categories
of services.
Form 5B: Sites (previously ``Service Modified fields collecting site
Sites''). information.
Form 6A: Current Board Member Removed patient board member
Characteristics. characteristics section.
Form 12: Organization Contacts......... Consolidated contact
information; kept two key
contacts.
Checklist for Adding a New Service..... Revised checklist statements
and questions.
Checklist for Adding a New Service Revised checklist statements
Delivery Site. and questions.
Checklist for Deleting Existing Service Revised checklist statements
and questions.
Checklist for Deleting Existing Service Revised checklist statements
Delivery Site. and questions.
HCCN Progress Report................... Clarified and updated
objectives; reduced the total
number of objectives.
Impact Form (previously ``Expanded Streamlined form to request
Services Patient Impact''). generic information based on
the Notice of Funding
Opportunity.
Loan Guarantee Program Financial Three questions removed.
Performance Measures (previously:
Financial Performance Indicators).
NHHCIA NCC Clinical Performance Minor language updates; no
Measures. content changes.
NHHCIA NCC Financial Performance Minor language updates; no
Measures. content changes.
NHHCIA NCC Income Analysis Form........ Question updates with targeted
adds/removals.
NH-NCC Project Work Plan Update........ Minor language updates; no
content changes.
Project Cover Page..................... Minor language updates; no
content changes.
Project Narrative Update............... Minor language updates; no
content changes.
Project Overview Form.................. Converted to a generic form
usable across funding
opportunities; updated
questions.
Project Qualification Criteria......... Removed 3 questions.
Project Work Plan...................... Updated to indicate which
questions are for PCAs vs
NTAPs. Updated minor language
updates.
Quality Improvement Fund (QIF) Minor language updates; no
Evaluative Measures Report. content changes.
QIF Progress Report.................... Minor language updates; no
content changes.
QIF Project Plan Form.................. Converted to a generic form
usable across funding
opportunities; updated
questions.
Summary Page (Service Area Competition) Aligned special medically
underserved population
terminology with statute;
minor language updates.
[[Page 21507]]
Summary Page (New Access Point)........ Aligned special medically
underserved population
terminology with statute;
minor language updates.
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HRSA will add the following forms necessary for data collection and
change in scope requests to simplify the process:
<bullet> Grant Number form
<bullet> Checklist for Adding a Transitional Care in Carceral Setting
Site to Scope
<bullet> QIF Transitions in Care for Justice-Involved Populations
Progress Report
<bullet> QIF Transitions in Care for Justice-Involved Populations
Evaluative Measures Report
<bullet> LAL Cover page
<bullet> Checklist for Form 5A Scope Adjustments
<bullet> Checklist for Form 5B Scope Adjustments
HRSA will remove the following forms to further streamline
information collected by HRSA and reduce burden:
<bullet> Applicant Qualification Criteria Form
<bullet> Checklist for Adding a New Target Population
<bullet> Environmental Information and Documentation
<bullet> Form 3A: Look-Alike Budget Information
<bullet> Form 4: Community Characteristics
<bullet> Fiscal Year 2020 Ending the HIV Epidemic Primary Care HIV
Prevention PCHP Progress Reporting
<bullet> HRSA EHBs Action Plan
<bullet> Patient Impact Form
<bullet> Patient Target and Calculations
<bullet> Progress Report--Non-Capital Investments
<bullet> Project Plan
Likely Respondents: Health Center Program award recipients (those
funded under section 330 of the Public Health Service 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.
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Number of Average burden
Form name Number of responses per Total per response Total burden
respondents respondent responses (hours) hours
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Capital Semi-Annual Progress 500 2 1,000 1.00 1,000.00
Report.........................
Checklist for Adding a New 450 1 450 2.00 900.00
Service........................
Checklist for Adding a New 1,480 1 1,480 2.00 2,960.00
Service Delivery Site..........
Checklist for Deleting Existing 500 1 500 2.00 1,000.00
Service........................
Checklist for Deleting Existing 750 1 750 2.00 1,500.00
Service Delivery Site..........
Equipment List.................. 130 1 130 0.50 65.00
Federal Object Class Categories 500 1 500 0.25 125.00
Form...........................
Loan Guarantee Program Financial 5 1 5 1.00 5.00
Performance Indicators
(previously: Financial
Performance Indicators)........
Form 1A: General Information 1,370 1 1,370 0.75 1,027.50
Worksheet......................
Form 1B: Funding Request Summary 900 1 900 0.75 675.00
Form 1C: Documents on File...... 1,460 1 1,460 0.50 730.00
Form 2: Staffing Profile........ 1,370 1 1,370 1.00 1,370.00
Form 3: Income Analysis......... 1,370 1 1,370 1.00 1,370.00
Form 5A: Services Provided...... 1,428 1 1,428 0.25 357.00
Form 5B: Sites (previously 1,428 1 1,428 0.25 357.00
``service sites'').............
Form 5C: Other Activities/ 550 1 550 0.25 137.50
Locations......................
Form 6A: Current Board Member 1,370 1 1,370 1.00 1,370.00
Characteristics................
Form 6B: Request for Waiver of 1,370 1 1,370 1.00 1,370.00
Board Member Requirements......
Form 8: Health Center Agreements 1,370 1 1,370 1.00 1,370.00
Form 12: Organization Contacts.. 970 1 970 0.50 485.00
Funding Sources................. 130 1 130 0.50 65.00
FY 2022 Accelerating Cancer 29 1 29 1.50 43.50
Screening Progress Report......
Grant Number Form............... 400 1 400 0.25 100.00
HCCN Progress Report............ 50 1 50 0.50 25.00
Health Center Program Progress 130 1 130 1.00 130.00
Report.........................
HRSA Loan Guarantee Program 5 1 5 1.00 5.00
Application....................
Impact Form (old name: Expanded 400 1 400 1.00 400.00
Services Patient Impact).......
NHHCIA NCC Clinical Performance 5 1 5 1.50 7.50
Measures.......................
NHHCIA NCC Financial Performance 5 1 5 0.50 2.50
Measures.......................
NHHCIA NCC Income Analysis Form. 5 1 5 0.15 0.75
NHHCIA Sample Project Work Plan. 2 1 2 0.15 0.30
NH-NCC Project Work Plan Update. 5 1 5 1.00 5.00
Operational Plan................ 350 1 350 2.00 700.00
Other Requirements for Sites.... 130 1 130 0.50 65.00
Participating Health Centers 90 1 90 1.00 90.00
List...........................
Project Cover Page.............. 130 1 130 1.00 130.00
[[Page 21508]]
Project Narrative Update........ 1,325 1 1,325 4.00 5,300.00
Project Overview Form........... 500 1 500 1.00 500.00
Project Qualification Criteria.. 130 1 130 0.50 65.00
Project Work Plan............... 508 1 508 4.00 2,032.00
Proposal Cover Page............. 130 1 130 1.00 130.00
QIF Evaluative Measures Report.. 25 2 50 1.50 75.00
QIF Progress Report............. 25 12 300 1.50 450.00
QIF TJI Evaluative Measures 54 10 540 1.50 810.00
Report.........................
QIF TJI Progress Report......... 54 10 540 1.50 810.00
QIF Project Plan Form........... 100 1 100 1.00 100.00
Summary Page (New Access Point). 500 1 500 1.00 500.00
Summary Page (Service Area 360 1 360 0.50 180.00
Competition)...................
LAL Cover page.................. 110 1 110 0.50 55.00
Checklist for Adding a 50 1 50 1.00 50.00
Transitional Care in a Carceral
Setting Site to Scope..........
Checklist for Form 5A Scope 1,875 1 1,875 0.50 937.50
Adjustments....................
Checklist for Form 5B Scope 1,695 1 1,695 0.50 847.50
Adjustments....................
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Total....................... 28,588 .............. 30,350.00 .............. 32,785.55
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Maria G. Button,
Director, Executive Secretariat.
[FR Doc. 2026-07793 Filed 4-21-26; 8:45 am]
BILLING CODE 4165-15-P
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