[Federal Register Volume 76, Number 176 (Monday, September 12, 2011)]
[Notices]
[Pages 56141-56143]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-23158]


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 Notices
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  Federal Register / Vol. 76, No. 176 / Monday, September 12, 2011 / 
Notices  

[[Page 56141]]



DEPARTMENT OF AGRICULTURE

Economic Research Service


Notice of Intent To Request New Information Collection

AGENCY: Economic Research Service, USDA.

ACTION: Notice and request for comments.

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SUMMARY: In accordance with the Paperwork Reduction Act of 1995, this 
notice invites the general public and other public agencies to send 
comments regarding any aspect of this proposed information collection. 
This is a new collection for a Survey on Rural Community Wealth and 
Health Care Provision.

DATES: Written comments on this notice must be received on or before 
November 14, 2011 to be assured of consideration.

ADDRESSES: Address all comments concerning this notice to John Pender, 
Resource and Rural Economics Division, Economic Research Service, U.S. 
Department of Agriculture, 1800 M. St., NW., Room N4056, Washington, DC 
20036-5801. Comments may also be submitted via fax to the attention of 
John Pender at 202-694-5774 or via e-mail to [email protected]. 
Comments will also be accepted through the Federal eRulemaking Portal. 
Go to http://www.regulations.gov, and follow the online instructions 
for submitting comments electronically.

FOR FURTHER INFORMATION CONTACT: For further information contact John 
Pender at the address in the preamble. Tel. 202-694-5568.

SUPPLEMENTARY INFORMATION: All written comments will be open for public 
inspection at the office of the Economic Research Service during 
regular business hours (8:30 a.m. to 5 p.m., Monday through Friday) at 
1800 M. St., NW., Room N4056, Washington, DC 20036-5801.
    All responses to this notice will be summarized and included in the 
request for Office of Management and Budget approval. All comments and 
replies will be a matter of public record. Comments are invited on: (a) 
Whether the proposed collection of information is necessary for the 
proper performance of the functions of the agency, including whether 
the information shall have practical utility; (b) the accuracy of the 
agency's estimate of the burden of the proposed collection of 
information, including the validity of the methodology and assumptions 
used; (c) ways to enhance the quality, utility, and clarity of the 
information to be collected; and (d) ways to minimize the burden of the 
collection of information on those who are to respond, including use of 
appropriate automated, electronic, mechanical, or other technological 
collection techniques or other forms of information technology.
    Title: Survey on Rural Community Wealth and Health Care Provision.
    OMB Number: 0536-XXXX.
    Expiration Date: Three years from the date of approval.
    Type of Request: New collection.
    Abstract: This survey will collect information on the assets and 
investments of rural communities and their influence on recruitment and 
retention of rural health care providers, and on the effects of rural 
health care provision on economic development of rural communities. 
This information will contribute to a better understanding of the roles 
that rural communities play in promoting or retarding the development 
and provision of health care services, and of how improved health care 
provision contributes to development of these communities. Such 
understanding is critical to develop effective policies to address the 
challenge of inadequate access to health care services in many rural 
communities, and to realize the opportunities offered by improved 
health care provision to attract and keep residents in rural areas, 
provide employment, and improve the quality of life.
    Health care services is one of the largest and most rapidly growing 
industries in rural America, and adequate provision of health care 
services is increasingly critical for achieving economic development 
and improved well-being of rural people. In many rural communities, 
health care services is the largest employer, and rapid growth in this 
sector is occurring and will continue to occur, especially as the Baby-
Boom generation retires. Provision of adequate health care services is 
likely to be one of the key factors in attracting retirees and other 
migrants to rural areas, helping to stem persistent outmigration from 
many of these areas and in some cases, contributing to rural growth and 
prosperity. Despite recent growth and potential for continued growth in 
this sector, many rural communities suffer from poor access to health 
care services, especially because of the limited supply of health care 
professionals. Addressing these access problems likely will become 
increasingly important as the Patient Protection and Affordable Care 
Act is implemented, increasing rural people's access to health 
insurance.
    Although substantial research has investigated the problems of 
attracting and retaining health care providers in rural areas, very 
little of this research addresses the issue from the perspective of 
rural communities themselves. For example, prior research has 
established that physicians who grew up in a rural area, who attended a 
medical school with a rural emphasis, or who completed a residency in a 
rural hospital are more likely than other physicians to locate their 
practice in a rural community. Policies and programs that provide 
incentives to physicians to locate in rural areas have also been shown 
to increase recruitment of physicians to rural areas, although the 
impacts on retention of physicians are more questionable. Much less 
research has focused on factors affecting recruitment and retention of 
health care providers other than physicians to rural areas, or on the 
roles local communities play in affecting these decisions. Of the 
research that investigates the roles of local communities, the studies 
have been conducted in only a few communities with a small number of 
respondents, limiting the ability to draw conclusions applicable to 
broader rural regions.
    The proposed rural community survey will address this information 
gap by collecting information from representatives of 150 rural 
communities in three regions of the United States and from health care 
providers in the same communities. The

[[Page 56142]]

survey will investigate the perspectives of community leaders and 
organizations concerning the need for improved access to health care 
services, the local community assets that attract or repel health care 
providers, the investments and efforts undertaken or planned to recruit 
and retain health care service providers, and the effects of changes in 
health care service provision on other aspects of community 
development. The survey will also investigate the perspective of health 
care providers on the factors affecting their decisions to locate, 
continue and change their operations in these rural communities, 
including the influence of community assets and investments such as 
improvements in local schools, availability of Internet broadband or 
other infrastructure, provision of child care services, recreational 
opportunities, and other factors.
    The three proposed study regions include the lower Mississippi 
Delta region (including parts of the States of Mississippi, Louisiana, 
Arkansas and Tennessee), the Southern Great Plains region (including 
parts of Texas, Oklahoma, Kansas, Nebraska, New Mexico, and Colorado), 
and part of the Upper Midwest region (including parts of Missouri, 
Iowa, Minnesota, Wisconsin and Illinois). These regions include areas 
with high rates of poverty and severe constraints to health care 
access--especially in the Delta and Southern Great Plains--while 
incomes and health care access are relatively more favorable in the 
Upper Midwest region. All three of these regions include rural areas 
where growth in health sector employment has been an important 
contributor to overall employment growth in recent years, as well as 
areas where less growth has occurred. These regions also include 
important variations in health status of the populations, presence of 
different racial and ethnic groups, social capital, and other key 
factors hypothesized to be related to rural health care provision.
    The communities (towns and surrounding counties and hospital 
service areas (HSAs)) studied in the survey will be selected using a 
stratified random sample. Potential respondents for each sampled 
community will be identified by accessing public information sources 
and by telephone screening. From the town, community leaders such as 
the town mayor, council representatives, business leaders or other 
stakeholders involved in recruiting and integrating health care 
providers to the community will be included on the respondent sample 
list. A sample of local health care providers in the selected town--in 
most cases limited to primary health care providers such as 
administrators of rural clinics, physicians, nurse practitioners, and 
dentists--will also be identified. At the county level, the list will 
include relevant representatives of the county government--such as the 
county executive and officials in the health and economic development 
departments--as well as civil society organizations and others involved 
at that level in seeking to improve health care provision. At the HSA 
level, the sample will include hospital administrators and other 
provider representatives. A total of 10 to 15 respondents will be 
interviewed in each selected community (including health care providers 
and leaders/stakeholders in the town, county and HSA). The interviews 
will be conducted by telephone and are expected to require on average 
about 20 minutes per respondent, based upon the experience of the 
organization that will implement the survey (Survey and Behavioral 
Research Services Group, Iowa State University) in implementing 
community level surveys of similar scope and size.
    The sample for each selected community will be strategically 
managed in order to provide the maximum survey response. Advance 
letters and a colorful information sheet/brochure will be mailed to 
potential respondents. A project Web site will be available with 
additional information, and a toll-free number will be provided for 
those who have questions or concerns. Confidentiality of responses will 
be both assured and ensured. After the advance letters/packets are 
sent, all reasonable efforts will be made to contact and interview the 
respondents in the sample. Paper or online copies of the survey will be 
made available to those who are unable or unwilling to complete a 
telephone interview.
    All study instruments will be kept as simple and respondent-
friendly as possible. Participation in the survey will be voluntary and 
confidential. Survey responses will be used for statistical analysis 
and to produce research reports only; not for any other purpose. Data 
files from the survey will not be released to the public. Responses 
will be linked to secondary data to augment information with no 
additional respondent burden. For example, the survey data will be 
combined with available county level data from the Census Bureau on 
community socioeconomic and demographic characteristics and data from 
the Department of Health and Human Services on health care provision 
and health status indicators, to analyze factors affecting local 
changes in health care provision.
    The telephone survey will be conducted within a six month period 
during 2012. After the telephone survey and analysis of its results are 
completed, a follow up information collection will be conducted in a 
sub-sample of the surveyed communities (at most 40), with the goal of 
deepening understanding of (i) how and why the community factors that 
appear to influence recruitment and retention of health care providers 
(as will be identified by the telephone survey) are able to do so, and 
(ii) how development of the health care sector contributes to broader 
economic development in rural communities. This second phase will use 
more qualitative methods, including in depth individual and focus group 
interviews, and will be completed in 2013. This notice focuses on the 
telephone survey; another notice will be provided before the second 
phase begins.

    Authority:  These data will be collected under the authority of 
7 U.S.C. 2204(a) and sec. 501 of the Rural Development Act of 1972 
(7 U.S.C. 2661). Individually identifiable data collected under this 
authority are governed by 7 U.S.C. 2276, which requires USDA to 
afford strict confidentiality to non-aggregated data provided by 
respondents. This Notice is submitted in accordance with the 
Paperwork Reduction Act of 1995, Pub. L. 104-13 (44 U.S.C. 3501, et 
seq.) and Office of Management and Budget regulations at 5 CFR part 
1320. ERS also complies with OMB Implementation Guidance, 
``Implementation Guidance for Title V of the E-Government Act, 
Confidential Information Protection and Statistical Efficiency Act 
of 2002 (CIPSEA)'', 72 FR 33362, June 15, 2007.

    Affected Public: Respondents will include health care providers, 
local government and community leaders, and other stakeholders involved 
in recruiting and retaining health care providers in rural communities.
    Estimated Number of Respondents and Respondent Burden: The 
telephone survey will be completed at one point in time within a six 
month period in 2012. The survey will have a complex mixed survey 
administration to include telephone screening, pre-notification letter 
with Web access, multi-contact telephone interviewing, and follow-up 
non-respondent mail questionnaires. The time required for respondents 
and non-respondents to read the notification materials, review 
instructions, participate in the screening interview, and decide 
whether to complete the questionnaire is estimated to average 15 
minutes per person. Completion time for each questionnaire respondent 
is estimated to average 20 minutes per completed questionnaire. In 
addition, the screening interviews used to select

[[Page 56143]]

the sample will involve telephone conversations with knowledgeable 
people in each community. We estimate that this may require 15 minute 
interviews with up to 8 people per community, or a maximum burden of 2 
hours per sample community.
    Full Study: The maximum sample size for the full study is 2,812 
respondents (15 respondents maximum per community x 150 communities/80% 
response rate). The expected overall response rate is 80 percent. The 
maximum total estimated response burden for all of those participating 
in the study is 1,313 hours (2,250 respondents x 35 minutes per 
respondent \1\) and for the non-respondents is 141 hours (562 non-
respondents x 15 minutes per non-respondent \2\). In addition, we 
estimate a maximum burden of 300 hours on non-sample interviewees 
contacted during the pre-sample screening process for the full study 
(150 communities x 8 interviewees/community x 15 minutes per 
interviewee).
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    \1\ The 35 minutes per respondent includes 15 minutes to review 
the materials, participate in the screening interview, and decide 
whether to participate, and 20 minutes to complete the 
questionnaire.
    \2\ The 15 minutes per non-respondent is to review the 
materials, participate in the screening interview, and decide 
whether to participate.
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    Pilot Study: A pilot test of the survey will be done in advance of 
the full survey. The purpose of the pilot is to evaluate the survey 
protocol, and test instruments and questionnaires. The initial sample 
size for this phase of the research is 100 respondents (10 respondents 
per community x 10 communities). The expected response rate is 80 
percent. The total estimated burden for full respondents in the pilot 
testing is 47 hours (100 respondents x 80 percent x 35 minutes per 
respondent), and for non-respondents is 5 hours (100 respondents x 20 
percent x 15 minutes per non-respondent). In addition, we estimate a 
maximum burden of 20 hours on non-sample interviewees contacted during 
the pre-sample screening process for the pilot study (10 communities x 
8 interviewees/community x 15 minutes per interviewee).
    The total respondent burden, including the pilot and full study, is 
estimated at 1,826 hours (see table below).

  Table--Estimated Respondent Burden for the Survey on Rural Community
                    Wealth and Health Care Provision
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             Item                Pilot study   Full study       Total
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Sample size...................           100         2,812         2,912
Responses
    --Number..................            80         2,250         2,330
    --Minutes/response........            35            35
    --Burden hours............            47         1,313         1,360
Non-responses
    --Number..................            20           562           582
    --Minutes/response........            15            15
    --Burden hours............             5           141           146
Pre-sample screening
 interviews
    --Number..................            80         1,200         1,280
    --Minutes/interview.......            15            15
    --Burden hours............            20           300           320
                               -----------------------------------------
    Total burden hours........            72         1,754         1,826
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    Dated: August 31, 2011.
Laurian Unnevehr,
Acting Administrator, Economic Research Service.
[FR Doc. 2011-23158 Filed 9-9-11; 8:45 am]
BILLING CODE 3410-18-P