[Federal Register Volume 81, Number 41 (Wednesday, March 2, 2016)]
[Notices]
[Pages 10875-10877]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-04535]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Agency Information Collection Activities: Proposed Collection: 
Public Comment Request

AGENCY: Health Resources and Services Administration, HHS.

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 
the Paperwork Reduction Act of 1995), the Health Resources and Services 
Administration (HRSA) announces plans to submit an Information 
Collection Request (ICR), described below, to the Office of Management 
and Budget (OMB). Prior to submitting the ICR to OMB, HRSA seeks 
comments from the public regarding the burden estimate, below, or any 
other aspect of the ICR.

DATES: Comments on this Information Collection Request must be received 
no later than May 2, 2016.

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

FOR FURTHER INFORMATION CONTACT: 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 
Information Collection Clearance Officer at (301) 443-1984.

SUPPLEMENTARY INFORMATION: When submitting comments or requesting 
information, please include the information request collection title 
for reference.
    Information Collection Request Title: Health Center Program 
Application Forms OMB No. 0915-0285--Revision
    Abstract: Health Centers (those entities funded under Public Health 
Service Act section 330 and Health Center Program 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; providing a wide range of medical, dental, behavioral, 
and social services. More than 1,300 health centers operate more than 
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 Center 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.
    Need and Proposed Use of the Information: BPHC Health Center 
Program-specific forms are critical to Health Center Program grant and 
non-grant award processes and for Health Center Program oversight. The 
purpose of these forms is to provide HRSA staff and objective review 
committee panels information essential for application evaluation, 
funding recommendation and approval, designation, and monitoring. These 
forms also provide HRSA staff with information essential for ensuring 
compliance with Health Center Program legislative and regulatory 
requirements. These application forms are used by existing health 
centers and other organizations to apply for various grant and non-
grant opportunities, renew their grant or non-grant designation, and 
change their scope of project.
    Most of the Health Center Program-specific forms do not require any 
changes with this revision. HRSA intends to revise some of the forms to 
streamline and clarify data already being requested (Form 1A, 1B, 2, 3, 
5A, 5B, 6A, 8, Performance Measures, Project Work Plan) and change 
several form names (changing Form 3A to Look-Alike Budget Information, 
Form 10 to Emergency Preparedness Report, and Increased Demand for 
Services to Project Narrative). HRSA also intends to add six new forms. 
The Supplemental Information form and Summary Page will consolidate 
important application information that is usually found distributed 
throughout the application, including eligibility criteria and 
projected goals. These forms would require applicant confirmation that 
the information provided is accurate. Two

[[Page 10876]]

additional forms would include the Program Narrative Update, used to 
report progress for the renewal of Health Center Program awards, and 
the Substance Abuse Progress Report, used to report quarterly progress 
for award recipients of Substance Abuse Expansion supplemental funding. 
Two other forms, the Health Center Controlled Networks Work Plan and 
Progress Report, are forms that have been used in the past (under 
another OMB control number) to collect application baseline data and 
progress metrics for grantees.
    Likely Respondents: Health Center Program award recipients and 
look-alikes, state and national technical assistance organizations, and 
other organizations seeking funding.
    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.

                                     Total Estimated Annualized Burden Hours
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                                                                                         Average
                                            Number of      Number of        Total      burden per   Total burden
                Form name                  respondents   responses per    responses   response (in      hours
                                                           respondent                    hours)
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Form 1A: General Information Worksheet..         1,700                1        1,700           1.0         1,700
Form 1B: BPHC Funding Request Summary...           450                1          450          0.75         337.5
Form 1C: Documents on File..............         1,000                1        1,000           0.5           500
Form 2: Staffing Profile................         1,700                1        1,700           1.0         1,700
Form 3: Income Analysis.................         1,900                1        1,900           2.5         4,750
Form 3A: FQHC Look-Alike Budget                    100                1          100           1.0           100
 Information............................
Form 4: Community Characteristics.......         1,000                1        1,000           1.0         1,000
Form 5A: Services Provided..............         1,700                1        1,700           1.0         1,700
Form 5B: Service Sites..................         1,200                1        1,200          0.75           900
Form 5C: Other Activities/Locations.....         1,000                1        1,000           0.5           500
Form 6A: Current Board Member                    1,000                1        1,000           0.5           500
 Characteristics........................
Form 6B: Request for Waiver of                     100                1          100           1.0           100
 Governance Requirements................
Form 8: Health Center Agreements........           600                1          600          0.75           450
Form 9: Need for Assistance Worksheet...           500                1          500           4.5         2,250
Form 10: Annual Emergency Preparedness           1,000                1        1,000           1.0         1,000
 Report.................................
Form 12: Organization Contacts..........         1,000                1        1,000           0.5           500
Clinical Performance Measures...........         1,000                1        1,000             2         2,000
Financial Performance Measures..........         1,000                1        1,000             1         1,000
Implementation Plan.....................           900                1          900           3.0         2,700
Project Work Plan.......................           200                1          200           4.0           800
Proposal Cover Page.....................           400                1          400           1.0           400
Project Cover Page......................           400                1          400           1.0           400
Equipment List..........................           400                1          400           1.0           400
Other Requirements for Sites............           400                1          400           0.5           200
Funding Sources.........................           400                1          400           0.5           200
Project Qualification Criteria..........           400                1          400           1.0           400
O&E Supplemental........................         1,200                1        1,200           1.0         1,200
O&E Progress Report.....................         1,200                1        1,200           1.0         1,200
Checklist for Adding a New Service                 700                1          700           2.0         1,400
 Delivery Site..........................
Checklist for Deleting Existing Service            700                1          700           2.0         1,400
 Delivery Site..........................
Checklist for Adding New Service........           700                1          700           2.0         1,400
Checklist for Deleting Existing Service.           700                1          700           2.0         1,400
Checklist for Replacing Existing Service           700                1          700           2.0         1,400
 Delivery Site..........................
Checklist for Adding a New Target                   50                1           50           1.0            50
 Population.............................
Increased Demand for Services...........         1,400                1        1,400             1         1,400
Supplemental Information (NEW)..........         2,000                1        2,000           0.5         1,000
Summary Page (NEW)......................         1,700                1        1,700          0.25           425
Program Narrative Update (NEW)..........           900                1          900             1           900
Substance Abuse Progress Report (NEW)...           300                4        1,200             1         1,200
Health Center Controlled Networks                   93                1           93            25         2,325
 Progress Report (NEW)..................
Health Center Controlled Networks Work              93                1           93             5           465
 Plan (NEW).............................
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    Total...............................        33,886  ...............       34,786  ............      43,652.5
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[[Page 10877]]

    HRSA specifically requests comments on (1) the necessity and 
utility of the proposed information collection for the proper 
performance of the agency's 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.

Jackie Painter,
Director, Division of the Executive Secretariat.
[FR Doc. 2016-04535 Filed 3-1-16; 8:45 am]
 BILLING CODE 4165-15-P