Notice2026-21385
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
October 20, 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. 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 201 (Tuesday, October 20, 2026)</title>
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[Federal Register Volume 91, Number 201 (Tuesday, October 20, 2026)]
[Notices]
[Pages 66337-66339]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-21385]
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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 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. 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 November
19, 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#215140514453564e534a61495352400f464e57"><span class="__cf_email__" data-cfemail="c9b9a8b9acbbbea6bba289a1bbbaa8e7aea6bf">[email protected]</span></a> or call
(301) 443-9094.
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. More than 1,400 health centers operate nearly 17,000
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 scopes of project.
A 60-day notice published in the Federal Register on July 30, 2026,
Vol. 91, No.145, pp. 48170-72. There were no public comments.
Need and Proposed Use of the Information: The information HRSA
collects from health centers via the Health Center Program-specific
forms is necessary for the agency's oversight of Health Center Program
awards. HRSA uses the information for program monitoring and for
evaluating award recipients' compliance with Health Center Program
statutory and regulatory requirements. These forms were approved by OMB
on May 31, 2026, following 60- and 30-day public comment periods. Eight
forms that were previously approved are being updated and three forms
are being added to facilitate monitoring, improve scope of project
documentation and oversight, increase the efficiency of the change in
scope process, and enhance the accuracy of change in scope requests.
[[Page 66338]]
HRSA will modify the following forms to update and clarify data
currently being collected:
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Forms proposed to be modified: No./name Description of modifications
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Form 5A: Services Provided............. Update labels and categories of
services.
Form 5B: Sites......................... Modify fields collecting site
information.
Checklist for Form 5A Scope Adjustments Revise checklist statements and
questions.
Checklist for Form 5B Scope Adjustments Revise checklist statements and
questions.
Checklist for Deleting a Service Site Revise checklist statements and
from Scope Previously: Checklist for questions.
Deleting Existing Service Delivery
Site.
Checklist for Adding a Service Site to Revise checklist statements and
Scope Previously: Checklist for Adding questions.
a New Service Delivery Site.
Checklist for Adding a Service to Scope Revise checklist statements and
Previously Checklist for adding a new questions.
service.
Checklist for Deleting a Service from Revise checklist statements and
Scope Previously: Checklist for questions.
deleting existing service.
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HRSA will add the following forms necessary for data collection and
change in scope requests to simplify the process:
<bullet> Checklist for Replacing a Service Site in Scope: Checklist
for updating a health center's scope to replace a service site.
<bullet> Quality Improvement Fund (QIF) Final Report: Collects data
on the award recipient's QIF project progress as directed by the notice
of funding opportunity.
<bullet> Loan Guarantee Progress Report: Used to monitor the status
of the loan after the guarantee is issued to ensure the health center
is compliant in meeting the terms and payment of the loan in the post
monitoring phase of the program.
Likely Respondents: Health Center Program award recipients (those
funded under section 330 of the Public Health Service Act) and Health
Center Program look-alikes.
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.
These updates will reduce the estimated annual burden by 1,621
hours based on the underlying unrounded burden calculations for the
currently approved collection. The reduction reflects modifications to
existing forms and the correction of the burden table to exclude Form
5C: Other Activities/Locations. Form 5C was removed from the package
during revisions completed earlier in 2026 and was inadvertently
retained in the published 60-day Federal Register notice burden table.
Compared with the 60-day notice, excluding Form 5C reduces the totals
by 550 respondents, 550 responses, and 137.50 burden hours. In the
burden table below, new forms are indicated through bold text, and
revised forms are indicated through italicized text. Except for the
correction regarding Form 5C described above, all other forms are
unchanged.
Total Estimated Annualized Burden Hours
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Number of Average burden
Form title Number of responses per Total per response Total burden
respondents respondent responses (hours) hours
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Form 5A: Services Provided...... 1,400 1 1400 0.25 350.00
Form 5B: Sites.................. 1,400 1 1400 0.25 350.00
Checklist for Form 5A Scope 1,000 1 1000 1.00 1,000.00
Adjustments....................
Checklist for Form 5B Scope 2,000 1 2000 1.00 2,000.00
Adjustments....................
Checklist for Deleting a Service 500 1 500 1.00 500.00
Site from Scope Previously:
Checklist for Deleting Existing
Service Delivery Site..........
Checklist for Adding a Service 1,250 1 1250 1.50 1,875.00
Site to Scope Previously:
Checklist for Adding a New
Service Delivery Site..........
Checklist for Adding a Service 450 1 450 1.00 450.00
to Scope Previously: Checklist
for adding a new service.......
Checklist for Deleting a Service 500 1 500 1.00 500.00
from Scope Previously:
Checklist for deleting existing
service........................
Checklist for Replacing a 250 1 250 0.75 187.50
Service Site in Scope..........
QIF Final Report................ 25 1 25 3.00 75.00
Loan Guarantee Progress Report.. 22 4 88 1.00 88.00
Capital Semi-Annual Progress 500 2 1,000 1.00 1,000.00
Report.........................
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.........
[[Page 66339]]
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 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
Health Center Controlled Network 50 1 50 0.50 25.00
Progress Report................
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..................... 400 1 400 1.00 400.00
Native Hawaiian Health Care 5 1 5 1.50 7.50
Improvement Act (NHHCIA) Non-
Competing Continuation (NCC)
Clinical Performance 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
Native Hawaiian-NCC Project Work 5 1 5 1.00 5.00
Plan Update....................
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
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 Transitions in Care for 54 10 540 1.50 810.00
Justice-Involved Populations
Evaluative Measures Report.....
QIF Transitions in Care for 54 10 540 1.50 810.00
Justice-Involved Populations
Progress Report................
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)...................
Look-Alike 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..........
Totals...................... 27,219.00 .............. 29,057.00 .............. 31,164.55
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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. 2026-21385 Filed 10-19-26; 8:45 am]
BILLING CODE 4165-15-P
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