[Federal Register Volume 72, Number 111 (Monday, June 11, 2007)]
[Notices]
[Pages 32124-32125]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-11219]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

    Periodically, the Health Resources and Services Administration 
(HRSA) publishes abstracts of information collection requests under 
review by the Office of Management and Budget (OMB), in compliance with 
the Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35). To request 
a copy of the clearance requests submitted to OMB for review, call the 
HRSA Reports Clearance Office on (301)-443-1129.
    The following request has been submitted to the Office of 
Management and Budget for review under the Paperwork Reduction Act of 
1995:

Proposed Project: The Health Center Program Application Forms: (OMB No. 
0915-0285 Extension)

    Health centers receiving grant funding under Section 330 of the 
Public Health Service (PHS) Act are a major component of America's 
health care safety net, the Nation's ``system'' of providing primary 
health care to underserved communities and vulnerable populations. 
Health centers care for people regardless of their ability to pay and 
whether or not they have health insurance. They provide primary health 
care, as well as services such as transportation and translation. Many 
health centers also offer dental, mental heath, and substance abuse 
care. Grants to health centers are administered by HRSA's Bureau of 
Primary Health Care (BPHC). In an effort to encourage the creation of 
new health centers and sites as well as improve and strengthen existing 
sites, HRSA periodically issues new grant opportunities.
    HRSA uses the following application forms to administer and manage 
the Federal Qualified Health Center. These application forms are used 
by new and existing FQHC's to apply for grant and non-grant 
opportunities, re-new their grant or non-grant opportunities or change 
their scope of project.
    Estimates of annualized reporting burden are as follows:

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                                                          Responses
        Type of application form            Number of        per          Total       Hours per    Total burden
                                           respondents   respondent     responses     response         hours
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General Information Worksheet...........         1,021             1         1,021           3.0           3,063
P12 Planning General Information                   300             1           300          12.0           3,600
 Worksheet..............................
BPHC Funding Request Summary............         1,021             1         1,021           0.5           510.5
Proposed Staff Profile..................         1,021             1         1,021           6.0           6,126
Income Analysis Form....................         1,021             1         1,021          15.0          15,315
Community Characteristics...............         1,021             1         1,021          12.0          12,252

[[Page 32125]]

 
Services Provided.......................         1,021             1         1,021           0.5           510.5
Sites Listing...........................         1,021             1         1,021           1.0           1,021
Other Site Activities...................           700             1           700           0.5             350
Board Member Characteristics............         1,021             1         1,021           1.0           1,021
Request for Waiver of Governance                   150             1           150           1.0             150
 Requirements...........................
Compliance Matrix.......................         1,021             1         1,021            .5           510.5
Health Center Affiliation Certification.           250             1           250            .5             125
Health Center Affiliation Checklist.....         1,021             1         1,021            .5           510.5
Need for Assistance.....................           900             1           900           6.0           5,400
Emergency Preparedness Form.............         1,021             1         1,021           1.0           1,021
FTCA Form...............................           800             1           800           1.0             800
Points of Contact.......................           800             1           800            .5             400
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    Total...............................         1,021  ............        15,131  ............          52,686
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    Written comments and recommendations concerning the proposed 
information collection should be sent within 30 days of this notice to: 
Karen Matsuoka, Human Resources and Housing Branch, Office of 
Management and Budget, New Executive Office Building, Room 10235, 
Washington, DC 20503.

    Dated: June 5, 2007.
Caroline Lewis,
Associate Administrator for Management.
[FR Doc. E7-11219 Filed 6-8-07; 8:45 am]
BILLING CODE 4165-15-P