[Federal Register Volume 73, Number 221 (Friday, November 14, 2008)]
[Notices]
[Pages 67527-67529]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-27115]


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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, e-mail 
[email protected] or 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: Ryan White HIV/AIDS Program: Client-Level Data 
Reporting System: New

    The Client-Level Data Reporting System (CLDRS), created in 2008 by 
the Health Resources and Services Administration (HRSA), was designed 
to collect information from grantees, as well as their subcontracted 
service providers, funded under Parts A, B, C, D, and F of the Ryan 
White HIV/AIDS Treatment Modernization Act of 2006 (Ryan White HIV/AIDS 
Program). The Ryan White HIV/AIDS Program provides Federal HIV/AIDS 
Programs under Title XXVI of the Public Health Service (PHS) Act with 
the flexibility to respond effectively to the changing HIV epidemic, 
with an emphasis on providing life-saving and life-extending services 
for people living with HIV/AIDS, and with targeting resources to areas 
that have the greatest needs.
    All Program Parts of the Ryan White HIV/AIDS Program specify HRSA's 
responsibilities in the administration of grant funds, the allocation 
of funds, the evaluation of programs for the population served, and the 
improvement of the quality of care. Accurate records of the providers 
receiving Ryan White HIV/AIDS Program funding, the services provided, 
and the clients served continue to be critical to the implementation of 
the legislation and thus are necessary for HRSA to fulfill its 
responsibilities.
    Currently, the HIV/AIDS Bureau (HAB) requires that all Ryan White 
HIV/AIDS Program funded grantees and their contracted service providers 
report aggregate data annually using the Ryan White Data Report (RDR). 
Agencies report data related to the service provider, clients, service 
visits provided/clients served, client demographics, and health 
insurance payments. Aggregate data by definition cannot be merged and 
unduplicated across service providers within a given geographic area. 
As a result, grantees, and ultimately HAB, cannot obtain accurate 
counts of the number of individuals served by the Ryan White HIV/AIDS 
Program. Additionally, aggregate data cannot be analyzed with the 
detail that is required to assess quality of care or to sufficiently 
account for the use of Ryan White HIV/AIDS Program funds.
    A well-designed and supported client level data reporting system, 
using a unique identifier that will be encrypted before transfer, would 
provide the grantee and HRSA with the requisite information to assess 
quality of care and unmet needs, and the ability to more accurately and 
efficiently report these figures to HAB and other funding agencies. 
These de-identified data will be able to accurately characterize the 
number of clients served by the Ryan White HIV/AIDS Program and the 
outcomes of the program services on a national scale.
    The CLDRS provides data on the characteristics of Ryan White HIV/
AIDS Program-funded grantees, their contracted service providers, and 
the clients being served with program funds. It is intended to support 
clinical quality management, performance measurement, service delivery, 
and client monitoring at both the system and client levels. The 
reporting system consists of two online data forms, the Grantee 
Information Form, the Service Provider Form and a data file containing 
the client-level data elements. Data will be submitted twice in the 
first year. The first submission will contain data for January through 
June, and the second submission will contain data for the entire 
calendar year. In subsequent years data will be collected on an annual 
basis.
    The new legislation specifies increased grantee accountability and 
linking performance to budget. The CLDRS will be used to ensure 
compliance with the requirements of the reauthorized legislation, 
evaluate the progress of programs, to monitor grantee and provider 
performance, measure the Government Performance and Result Act (GPRA) 
and the Performance Assessment Rating Tool (PART) goals, and meet 
reporting responsibilities to the Department, Congress, and OMB.
    In addition to meeting the goal of accountability to Congress, 
clients, advocacy groups, and the general public, information collected 
through the CLDRS is critical for HRSA, State and local grantees, and 
individual providers to assess the status of existing HIV-related 
service delivery systems to investigate trends in service utilization, 
and to identify areas of greatest need.
    Discussions were conducted with volunteer grantee agencies 
representing Parts A, B, C, D, and Minority AIDS Initiatives, Parts A 
and B, as a basis for the burden estimates for the CLDRS components 
that follow. These burden estimates are broken out by burden to grantee 
respondents and burden to provider respondents, and are presented in 
two tables. The first table represents the estimated burden for the 
first year data submission. The second table represents the estimated 
burden for years two and three.
    The number of total burden hours for the CLD Collection System is 
estimated differently in year 1 than in years 2 and 3. The estimate for 
the first year

[[Page 67528]]

submission is based on providers that reported outpatient/ambulatory 
medical care, medical case management, and/or non-medical case 
management services in the 2007 Ryan White Data Report. These providers 
will be required to report client level data beginning in 2009. This 
first year estimate excludes providers of other direct client services 
(services other than those listed above) because these providers will 
not be required to report client level data until 2010. The estimate 
for years 2 and 3 include all providers that reported direct client 
services in the 2007 Ryan White Data Report. The mean of the total 
burden hours for years 1, 2, and 3 is 88,191 hours per year.
    The total burden hours for the Client Report is estimated two ways. 
The first estimate is based on the number of providers that do not have 
and will not develop an electronic data system (approximately 3% of 
providers). The second estimate is based on the number of providers 
that will submit their Client Report using an electronic data system.
    The estimated response burden for the first reporting period CLDRS 
submission is as follows:

                                 Table 1--Estimates of Average Annualized Hour Burden to Respondents for the First Year
                                                             [Two 6-month reporting periods]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                             Hours to
                                                                                                                             complete/
                 Component                        Source of funding          Number of     Responses per       Total        coordinate     Total burden
                                                                            respondents       grantee        responses      receipt of         hours
                                                                                                                           data reports
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                 Grantee Response Burden
--------------------------------------------------------------------------------------------------------------------------------------------------------
Grantee Report............................  Part A......................              56               2             112            1.27             142
                                            Part B......................              57               2             114            6.00             684
                                            Part C......................             357               2             714            0.39             278
                                            Part D......................              90               2             180            0.67             121
                                            Part A MAI..................              56               2             112            1.27             142
                                            Part B MAI..................              30               2              60           10.00             600
                                                                         -------------------------------------------------------------------------------
                                            Subtotal....................  ..............             646  ..............  ..............           1,967
--------------------------------------------------------------------------------------------------------------------------------------------------------


 
                                                                                                                             Hours to
                 Component                                                   Number of     Responses per       Total      develop/adjust   Total burden
                                                                            respondents      provider        responses      CLD system         hours
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                            Service Provider Response Burden
--------------------------------------------------------------------------------------------------------------------------------------------------------
CLD Collection System.....................  ............................  [dagger] 1,466               1           1,466           92.80         136,045
--------------------------------------------------------------------------------------------------------------------------------------------------------


 
                                                                             Number of     Responses per       Total         Hours per     Total burden
                 Component                                                  respondents      provider        responses       response          hours
--------------------------------------------------------------------------------------------------------------------------------------------------------
Provider report...........................  ............................       *[dagger]               2           4,506            2.35          10,589
                                                                                   2,253
--------------------------------------------------------------------------------------------------------------------------------------------------------


 
                                                                                                                             Hours to
                                             Providers' Electronic Data      Number of     Responses per       Total      collect/report   Total burden
                 Component                       Systems Capability         respondents      provider        responses       data per          hours
                                                                                                                             response
--------------------------------------------------------------------------------------------------------------------------------------------------------
Client Report (client-level data).........  No..........................              45               2              90          106.25           9,563
                                            Yes.........................  [dagger] 1,466               2           2,932            3.75          10,995
                                                                         -------------------------------------------------------------------------------
                                               Subtotal.................        ** 1,511  ..............  ..............  ..............          20,558
                                                                         -------------------------------------------------------------------------------
        TOTAL BURDEN, YEAR 1............................................................................................................         169,159
--------------------------------------------------------------------------------------------------------------------------------------------------------
* All providers, including direct service providers and administrative support service-only providers.
** Outpatient/ambulatory medical care, medical case management, and/or nonmedical case management providers that will submit a Client Report in 2009.
[dagger] These numbers are not duplications.


                           Table 2--Estimates of Average Annualized Hour Burden to Respondents for the Second and Third Years
                                                             [One reporting period per year]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                             Hours to
                                                                                                                             complete/
                 Component                        Source of funding          Number of     Responses per       Total        coordinate     Total burden
                                                                            respondents       grantee        responses      receipt of         hours
                                                                                                                           data reports
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                 Grantee Response Burden
--------------------------------------------------------------------------------------------------------------------------------------------------------
Grantee Report............................  Part A......................              56               1              56            1.27              71
                                            Part B......................              57               1              57            6.00             342
                                            Part C......................             357               1             357            0.39             139
                                            Part D......................              90               1              90            0.67              60
                                            Part A MAI..................              56               1              56            1.27              71
                                            Part B MAI..................              30               1              30           10.00             300
                                                                         -------------------------------------------------------------------------------

[[Page 67529]]

 
                                               Subtotal.................  ..............             646  ..............  ..............             983
--------------------------------------------------------------------------------------------------------------------------------------------------------


 
                                                                                                                             Hours to
                 Component                                                   Number of     Responses per       Total      develop/adjust   Total burden
                                                                            respondents      provider        responses      CLD system         hours
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                            Service Provider Response Burden
--------------------------------------------------------------------------------------------------------------------------------------------------------
CLD Collection System.....................  ............................             583               1             583           92.80          54,102
--------------------------------------------------------------------------------------------------------------------------------------------------------


 
                                                                             Number of     Responses per       Total         Hours per     Total burden
                 Component                                                  respondents      provider        responses       response          hours
--------------------------------------------------------------------------------------------------------------------------------------------------------
Provider Report...........................  ............................          2,253*               1           2,253            2.35           5,295
--------------------------------------------------------------------------------------------------------------------------------------------------------


 
                                                                                                                             Hours to
                                             Providers' electronic data      Number of     Responses per       Total      collect/report   Total burden
                 Component                       systems capability         respondents      provider        responses       data per          hours
                                                                                                                             response
--------------------------------------------------------------------------------------------------------------------------------------------------------
Client Report (client-level data).........  No..........................              63               1              63          106.25           6,694
                                            Yes.........................           2,049               1           2,049            3.75           7,684
                                                                         -------------------------------------------------------------------------------
                                               Subtotal.................                        ** 2,112  ..............  ..............          14,378
                                                                         -------------------------------------------------------------------------------
        TOTAL BURDEN, YEAR 2............................................................................................................          74,758
        TOTAL BURDEN, YEAR 3............................................................................................................          20,656
--------------------------------------------------------------------------------------------------------------------------------------------------------
[dagger] All providers, including direct service providers and administrative support service-only providers.
[dagger][dagger] All direct service providers, including those outpatient/ambulatory medical care, medical case management, and/or nonmedical case
  management providers that will submit a Client Report in 2009 as well as other direct service providers that will submit a Client Report in 2010.
\a\ There is no CLD Collection system adjustment in Year 3, so the total burden is less.

    Written comments and recommendations concerning the proposed 
information collection should be sent within 30 days of this notice to 
the desk officer for HRSA, either by e-mail to [email protected] or by fax to 202-395-6974. Please direct all 
correspondence to the ``attention of the desk officer for HRSA.''

    Dated: November 7, 2008.
Alexandra Huttinger,
Director, Division of Policy Review and Coordination.
[FR Doc. E8-27115 Filed 11-13-08; 8:45 am]
BILLING CODE 4165-15-P