[Federal Register Volume 78, Number 85 (Thursday, May 2, 2013)]
[Notices]
[Pages 25750-25752]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-10377]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Agency Information Collection Activities: Proposed Collection: 
Comment Request

ACTION: Notice.

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SUMMARY: In compliance with the requirement for opportunity for public 
comment on proposed data collection projects (Section 3506(c)(2)(A) of 
Title 44, United States Code, as amended by the Paperwork Reduction Act 
of 1995, Pub. L. 104-13), the Health Resources and Services 
Administration (HRSA) publishes periodic summaries of proposed projects 
being developed for submission to the Office of Management and Budget 
(OMB) under the Paperwork Reduction Act of 1995. To request more 
information on the proposed project or to obtain a copy of the data 
collection plans and draft instruments, email [email protected] or 
call the HRSA Reports Clearance Officer at (301) 443-1984.
    HRSA especially requests comments on: (1) The necessity and utility 
of the proposed information collection for the proper performance of 
the agency's

[[Page 25751]]

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.
    Information Collection Request Title: Health Center Program 
Application Forms: (OMB No. 0915-0285 Revision).
    Abstract: Health centers (section 330 grant funded and Federally 
Qualified Health Center Look-Alikes) deliver comprehensive, high 
quality, cost-effective primary health care to patients regardless of 
their ability to pay. Health centers have become an essential primary 
care provider for America's most vulnerable populations. Health centers 
advance the preventive and primary medical/health care home model of 
coordinated, comprehensive, and patient-centered care, coordinating a 
wide range of medical, dental, behavioral, and social services. More 
than 1,200 health centers operate nearly 9,000 service delivery sites 
that provide care in every state, the District of Columbia, Puerto 
Rico, the U.S. Virgin Islands, and the Pacific Basin.
    The Health Centers Program is administered by HRSA's Bureau of 
Primary Health Care (BPHC). HRSA/BPHC uses the following application 
forms to oversee the Health Center Program. These application forms are 
used by new and existing Health centers to apply for various grant and 
non-grant opportunities, renew their grant or non-grant designation, 
and change their scope of project.
    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 Information Collection Request are summarized in the table below.
    The annual estimate of burden is as follows:

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                                                                                      Average
                                     Number of       Number of         Total        burden per     Total burden
    Type of application form        respondents    responses per     responses     response  (in       hours
                                                    respondent                        hours)
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Form 1A: General Information               1,350               1           1,350             2.0           2,700
 Worksheet......................
Planning Grant: General                      250               1             250             2.5             625
 Information Worksheet..........
Form 1B: BPHC Funding Request              1,200               1           1,350             2.0           2,700
 Summary........................
Form 1C: Documents on File......           1,350               1           1,350             1.0           1,350
Form 2: Proposed Staff Profile..           1,350               1           1,350             2.0           2,700
Form 3: Income Analysis Form....           1,200               1           1,200             5.0           6,000
Form 4: Community                          1,350               1           1,350             1.0           1,350
 Characteristics................
Health Care Plan (Competing)....             800               1             800             2.0           1,600
Health Care Plan (Non-Competing)             550               1             550             1.0             550
Business Plan (Competing).......             800               1             800             2.0           1,600
Business Plan (Non-Competing)...             550               1             550             1.0             550
Form 5A: Services Provided......             700               1             700             1.0             700
Form 5B: Sites Listing..........             700               1             700             1.0             700
Form 5C: Other Site Activities..             700               1             700             0.5             350
Change In Scope (CIS) Site--Add              700               1             700             1.0             700
 Checklist......................
CIS Site--Delete Checklist......             700               1             700             1.0             700
CIS Relocation Checklist........             700               1             700             1.0             700
CIS Service--Add Checklist......             700               1             700             1.0             700
CIS Service--Delete Checklist...             700               1             700             1.0             700
Add New Target Population.......              50               1              50             1.0              50
Form 6A: Board Member                      1,350               1           1,350             1.0           1,350
 Characteristics................
Form 6B: Request for Waiver of               150               1             150             1.0             150
 Governance Requirements........
Form 8: Health Center                        250               1             250             1.0             250
 Affiliation Certification......
Form 9: Need for Assistance.....             400               1             400             3.0           1,200
Form 10: Emergency Preparedness            1,350               1           1,350             1.0           1,350
 Form...........................
Form 12: Organization Points of            1,350               1           1,350             0.5             675
 Contact........................
EHR Readiness Checklist.........             250               1             250             1.0             250
Environmental Information and                400               1             400             2.0             800
 Documentation (EID)............
Assurances......................             900               1             900              .5             450
Equipment List..................             400               1             400             1.0             400
Other Requirements for Sites....             400               1             400              .5             200
Project Work Plan...............             400               1             400             1.0             400
Summary Page....................             400               1             400              .5             200
Verification Check List.........             200               1             200              .5             100
Alteration/Renovation (A/R)                  400               1             400             1.0             400
 Project cover Page.............
Proposal Cover Page.............             400               1             400             1.0             400
Consolidated Budget.............             400               1             400              .5             200
Consolidated Funding Sources....             400               1             400             1.0             400
Project Qualification Criteria..             400               1             400             1.0             400
Project Cover Page..............             400               1             400              .5             200
Other Project Document..........             400               1             400             1.0             400
Funding Sources.................             400               1             400              .5             200
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    Total.......................           1,350               1          27,950  ..............          37,400
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[[Page 25752]]


ADDRESSES: Submit your comments to [email protected] or mail the HRSA 
Reports Clearance Officer, Room 10-29, Parklawn Building, 5600 Fishers 
Lane, Rockville, MD 20857.

DATES: Deadline: Comments on this Information Collection Request must 
be received within 60 days of this notice.

    Dated: April 26, 2013.
Bahar Niakan,
Director, Division of Policy and Information Coordination.
[FR Doc. 2013-10377 Filed 5-1-13; 8:45 am]
BILLING CODE 4165-15-P