[Federal Register Volume 78, Number 116 (Monday, June 17, 2013)]
[Notices]
[Pages 36160-36162]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-14202]


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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 (44 
U.S.C. Chapter 35), this notice announces the Economic Research 
Service's intention to request approval for a new information 
collection for a Survey on Rural Community Wealth and Health Care 
Provision.

DATES: Comments must be received by August 16, 2013 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, 1400 Independence Ave. SW., Mailstop 1800, 
Washington, DC 20250-0002. Comments may also be submitted via fax to 
the attention of John Pender at 202-694-5773 or via email to 
[email protected].

FOR FURTHER INFORMATION CONTACT: John Pender, [email protected]. 
Tel. 202-694-5568.

SUPPLEMENTARY INFORMATION:
    Title: Survey on Rural Community Wealth and Health Care Provision.
    OMB Number: To be assigned by OMB.
    Expiration Date: Three years from the date of approval.
    Type of Request: New information collection.
    Abstract: The primary purpose of the proposed survey is to collect 
information on how rural small towns can attract and retain primary 
health care providers, considering the broad range of assets and 
amenities that may attract providers. The secondary purpose is to 
provide information on

[[Page 36161]]

how improving health care may affect economic development prospects of 
rural small towns. The Economic Research Service (ERS) intends to 
address these purposes by collecting primary data from health care 
providers and community leaders in 150 rural small towns in nine states 
in three regions: Mississippi, Louisiana, and Arkansas (representing 
the Mississippi Delta region); Texas, Oklahoma, and Kansas (Southern 
Great Plains region); and Iowa, Minnesota, and Wisconsin (Upper Midwest 
region).
    This information will contribute to improved understanding of the 
roles that rural communities play in attracting and retaining health 
care providers, and of how improved health care provision contributes 
to economic development of these communities. Such understanding is 
critical to develop effective policies and local strategies 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 and businesses in 
rural areas, provide employment, and improve the quality of life.
    The study will focus on small rural towns (population 2,500 to 
20,000) because it is expected that the ability to attract and retain 
health care providers is most likely to be affected by local assets and 
amenities for such towns. The universe of small towns in the three 
regions selected include about 9 percent of the rural population of the 
United States and represent considerable diversity in levels of 
economic development and access to health care services. The set of 150 
small towns included in the study will be selected using a probability 
based sample, so that the information collected will be representative 
of this universe of rural small towns in the nine states.
    Although much research has investigated the problems of attracting 
and retaining health care providers in rural areas, very little 
research addresses the relationships between economic development and 
health care provision in rural areas. Virtually no research addresses 
the issue from the perspective of rural communities themselves, 
investigating whether and how rural communities seek to attract and 
keep health care providers, and how they think this influences their 
economic development prospects. The proposed information collection 
will address this information gap. It will consist of three phases: (1) 
Key informant telephone interviews with select local government leaders 
and health care administrators in the study towns; (2) a dual mode 
telephone/mail survey of primary health care providers in the towns; 
and (3) follow up focus groups and/or in-person key informant 
interviews in a subset of selected towns. The information collected 
will be augmented by publicly available secondary information on health 
care provision and economic development in the study regions.
    The objectives of the initial key informant interviews with local 
government leaders and health care administrators are to collect or 
verify information assembled from secondary sources on (i) which health 
care services and providers are available in the town, (ii) how 
provision of health care services in the town has changed in the past 
five years, (iii) the extent to which recruiting and retaining health 
care providers is seen as a priority by leaders in the town, (iv) what 
efforts have been made to recruit and retain providers, and (v) 
perceived impacts of these efforts on aspects of economic development 
in the town. Key informant interviews will be conducted with up to four 
individuals, including at least one representative of the local 
government--either the chief executive officer (mayor or city/town 
manager) or a knowledgeable representative designated by that officer--
and the administrator of at least one primary health care facility 
(hospital or clinic), if such facilities are available, in the town. If 
a hospital or clinic is not available in the town, other informants 
with knowledge about health care in the town will be sought. Semi-
structured interviews will be used, and are expected to last up to 60 
minutes each. The key informant interviews will be conducted before the 
telephone/mail survey of health care providers, since they will help to 
validate the sample frame of providers and may yield information useful 
in the design of the provider survey.
    The dual mode telephone/mail survey will investigate the 
perspective of primary health care providers in rural small towns on 
the factors affecting their decisions to locate, continue and change 
their operations in these rural communities, including the influence of 
community assets and amenities. The target population of health care 
providers includes primary care physicians, physician assistants, nurse 
practitioners, certified nurse midwives, and dentists. A random sample 
of up to 8 health care providers will be surveyed in each sample town. 
The telephone interviews are expected to average about 20 minutes per 
respondent, based upon cognitive interviews testing a draft of the 
survey instrument with three rural health care providers. Paper copies 
of the survey will be mailed to those who are unable or unwilling to 
complete a telephone interview. It is expected that the paper surveys 
will also require about 20 minutes to complete.
    After the provider survey and analysis of its results are 
completed, focus groups and/or follow up key informant interviews 
(possibly including some of the people interviewed during the initial 
key informant interviews) will be conducted in person 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. The communities included in this 
phase of the study will be purposefully selected to be representative 
of different conditions with regard to region, access to health care 
providers, and level of economic development. Participants will be 
individuals knowledgeable about health care and/or economic development 
issues in the community, including representatives of local government, 
the business sector, the non-profit sector, and the health care 
industry. Current plans are to conduct at least one focus group with up 
to 10 participants in each of the sub-sample of communities, with one-
on-one semi-structured interviews as circumstances require. We expect 
to interview no more than 12 people per community regardless of whether 
one or more focus groups or one-on-one interviews are conducted. It is 
anticipated that each focus group and one-on-one interview will last 60 
minutes. A semi-structured instrument will be used to guide these focus 
groups and interviews.
    All study instruments will be kept as simple and respondent-
friendly as possible. Participation in the interviews will be voluntary 
and confidential. Survey responses will be used for statistical 
analysis and to produce research reports only; not for any other 
purpose. 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 town and 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, to analyze factors affecting local 
changes in health care provision.


[[Page 36162]]


    Authority:  These data will be collected under the authority of 
7 U.S.C. 2204(a) and 7 U.S.C. 2661. ERS will comply 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. Respondent information will be protected under the CIPSEA and 
the 7 U.S.C. 2276.

    Estimate of Burden: Public reporting burden for this collection of 
information is estimated to average 0.91 hours per response.
    Type of Respondents: Respondents to the first phase key informant 
telephone interviews will include chief executive officers (or their 
designated representatives) of the towns, administrators of health care 
facilities (in towns having such facilities), or other individuals 
knowledgeable about health care (particularly in towns not having such 
facilities) in the 150 rural small towns selected for the study. 
Respondents in the second phase telephone survey will include primary 
health care providers in the selected towns, including primary care 
physicians, physician assistants, nurse practitioners, certified nurse 
midwives, and dentists. Respondents in the third phase focus groups and 
in-person key informant interviews will include representatives of 
local government, the local health care industry, businesses, and non-
profit organizations concerned with health care and/or economic 
development.
    Estimated Number of Respondents: (i) Key informant telephone 
interviews: 4 respondents per community x 150 communities = 600 
respondents (assuming 67% response rate); (ii) Telephone/mail survey of 
health care providers: 8 respondents per community (assuming 80% 
response rate) x 150 communities = 1,200 respondents; (iii) Focus group 
participants and key informant interviews: 12 respondents per community 
x 40 communities = 480 respondents (assuming 80% response rate). Total 
number of respondents = 2,280. Total number of non-respondents = 720.
    Estimated Number of Responses: 2,280 from respondents, 720 refusals 
from non-respondents.
    Estimated Number of Responses per Respondent: 1.08 maximum, if all 
respondents in first phase key informant interviews participate in 
third phase focus groups/interviews.
    Estimated Total Burden on Respondents: 2,730 hours (see table for 
details).

                                                                    Reporting Burden
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                                                                                                                             Estimated       Estimated
                                                                    Estimated number  Responses or non-                   average number  total hours of
                            Description                              of respondents     responses per    Total responses  of minutes per   response and
                                                                         or non-         respondent     or non-responses    response or    non-response
                                                                       respondents                                         non-response       burden
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                                                       Phase 1: Key informant telephone interviews
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Identify and contact key informants--admin. Staff.................               900                 1               900              10             150
Respondents review request and decide.............................               600                 1               600              15             150
Key informant interviews..........................................               600                 1               600              60             600
Non-respondents review request and decline........................               300                 1               300              15              75
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                                               Phase 2: Telephone/Mail surveys with health care providers
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Identify and contact respondents..................................              1500                 1              1500              10             250
Respondents review request........................................              1200                 1              1200              15             300
Telephone/Mail surveys............................................              1200                 1              1200              20             400
Non-respondents review request and decline........................               300                 1               300              15              75
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                                              Phase 3: Focus group and in-person key informant interviews
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Identify and contact participants.................................               600                 1               600              10             100
Participants review request.......................................               480                 1               480              15             120
Focus groups & key informant interviews...........................               480                 1               480              60             480
Non-respondents review request and decline........................               120                 1               120              15              30
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    Total Burden..................................................  ................  ................  ................  ..............           2,730
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    Comments: Comments are invited on: (1) Whether the proposed 
collection of information is necessary for the proper performance of 
the functions of the agency, including whether the information will 
have practical utility; (2) 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; (3) ways to enhance 
the quality, utility, and clarity of the information to be collected; 
and (4) ways to minimize the burden of the collection of information on 
those who are to respond, including the use of appropriate automated, 
electronic, mechanical, or other technological collection techniques or 
other forms of information technology. Comments may be sent to John 
Pender, Resource and Rural Economics Division, Economic Research 
Service, U.S. Department of Agriculture, 1400 Independence Ave. SW., 
Mailstop 1800, Washington, DC 20250-0002. Comments may also be 
submitted via fax to the attention of John Pender at 202-694-5773 or 
via email to [email protected]. All comments received will be 
available for public inspection during regular business hours at the 
same address.
    All responses to this notice will be summarized and included in the 
request for OMB approval. All comments will become a matter of public 
record.

    Dated: June 10, 2013.
Mary Bohman,
Administrator, Economic Research Service.
[FR Doc. 2013-14202 Filed 6-14-13; 8:45 am]
BILLING CODE 3410-18-P