[Federal Register Volume 75, Number 112 (Friday, June 11, 2010)]
[Notices]
[Pages 33310-33311]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-14108]


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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: Federally Qualified Health Centers (FQHC) Application 
Forms: (OMB No. 0915-0285)--Revisions

    HRSA's Bureau of Primary Health Care administers grants to Health 
Centers receiving funding under section 330 of the Public Health 
Service Act and has an approval process for organizations seeking to 
qualify as Federally Qualified Health Center (FQHC) Look Alikes. These 
Health Centers and FQHC Look Alikes provide preventive and primary 
health care services to low-income and other vulnerable populations, 
regardless of their ability to pay and whether or not they have health 
insurance. Many Health Centers and FQHC Look-Alikes offer dental, 
mental health and substance abuse care.
    HRSA uses the following application forms to administer Section 330 
Health Centers grants and the FQHC Look Alike application process. 
These application forms are used by new and existing Health Centers and 
FQHC Look-Alikes to apply for grant and non-grant opportunities, renew 
their grant or non-grant opportunities or change their scope of 
project.
    Estimates of annualized reporting burden are as follows:

----------------------------------------------------------------------------------------------------------------
                                    Number of     Responses per       Total         Hours per      Total burden
    Type of application form       respondents     respondent       responses        response          hours
----------------------------------------------------------------------------------------------------------------
General Information Worksheet..           1,034               1           1,034              2.0           2,068
Planning Grant: General                     250               1             250              2.5             625
 Information Worksheet.........
BPHC Funding Request Summary...           1,034               1           1,034              2.0           2,068
Documents on File..............           1,034               1           1,034              1.0           1,034
Proposed Staff Profile.........           1,034               1           1,034              2.0           2,068
Income Analysis Form...........           1,034               1           1,034              5.0           5,170
Community Characteristics......           1,034               1           1,034              1.0           1,034
Health Care Plan (Competing)...             800               1           1,034              4.0           4,136
Health Care Plan (Non-                    1,034               1           1,034              2.0           2,068
 Competing)....................
Business Plan (Competing)......             800               1           1,034              4.0           4,136

[[Page 33311]]

 
Business Plan (Non-Competing)..           1,034               1           1,034              2.0           2,068
Services Provided..............           1,034               1           1,034              1.0           1,034
Sites Listing..................           1,034               1           1,034              1.0           1,034
Other Site Activities..........             700               1             700              0.5             350
Change In Scope (CIS) Site Add              300               1             300              1.0             300
 Checklist.....................
CIS Site Delete Checklist......             200               1             200              1.0             200
CIS Relocation Checklist.......             200               1             200              1.5             300
CIS Service Add Checklist......             100               1             200              1.0             200
CIS Service Delete Checklist...             100               1             100              1.0             100
Board Member Characteristics...           1,034               1           1,034              1.0           1,034
Request for Waiver of                       150               1             150              1.0             150
 Governance Requirements.......
Health Center Affiliation                   250               1             250              1.0             250
 Certification.................
Need for Assistance............             900               1             900              3.0           2,700
Emergency Preparedness Form....           1,034               1           1,034              1.0           1,034
Points of Contact..............             800               1             800              0.5             400
EHR Readiness Checklist........             250               1             250              1.0             250
Environmental Information and               400               1             400              2.0             800
 Documentation (EID)...........
Capital Improvement/Investment              700               1             700              1.0             700
 Proposal Cover Page...........
Assurances.....................             900               1             900               .5             450
Capital Improvement/Investment              700               1             700              1.0             700
 Project Cover.................
Capital Improvement/Investment              700               1             700               .5             350
 Project Impact................
Equipment List.................             900               1             900              1.0             900
Other Requirements for Sites...             900               1             900               .5             450
                                --------------------------------------------------------------------------------
    Total......................           1,138               1          23,976  ...............          40,161
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    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 email to [email protected] or by fax to 202-395-6974. Please direct all 
correspondence to the ``attention of the desk officer for HRSA.''

    Dated: June 7, 2010.
Sahira Rafiullah,
Director, Division of Policy and Information Coordination.
[FR Doc. 2010-14108 Filed 6-10-10; 8:45 am]
BILLING CODE 4165-15-P