[Federal Register Volume 84, Number 67 (Monday, April 8, 2019)] [Notices] [Pages 13937-13938] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 2019-06766] ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Agency Information Collection Activities: Proposed Collection: Public Comment Request: Information Collection Request Title: Health Center Program Forms, OMB No. 0915-0285--Revision AGENCY: Health Resources and Services Administration (HRSA), Department of Health and Human Services. ACTION: Notice. ----------------------------------------------------------------------- SUMMARY: In compliance with the requirement for opportunity for public comment on proposed data collection projects of the Paperwork Reduction Act of 1995, 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 ICR should be received no later than June 7, 2019. ADDRESSES: Submit your comments to [email protected] or mail the HRSA Information Collection Clearance Officer, Room 14N136B, 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 Lisa Wright- Solomon, 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 Forms; OMB No. 0915-0285--Revision. Abstract: The Health Center Program, administered by HRSA, is authorized under section 330 of the Public Health Service (PHS) Act, most recently amended by section 50901(b) of the Bipartisan Budget Act of 2018, Public Law 115-123. Health centers are community-based and patient-directed organizations that deliver affordable, accessible, quality, and cost-effective primary health care services to patients regardless of their ability to pay. Nearly 1,400 health centers operate approximately 12,000 service delivery sites that provide primary health care to more than 27 million people in every U.S. state, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin. HRSA utilizes forms for new and existing health centers and other entities to apply for various grant and non-grant opportunities, renew grant and non-grant designations, report progress, and change their scopes of project. Need and Proposed Use of the Information: Health Center Program- specific forms are necessary for Health Center Program award processes and oversight. These forms provide HRSA staff and objective review committee panels with information essential for application evaluation, funding recommendation and approval, designation, and monitoring. These forms also provide HRSA staff with information essential for evaluating compliance with Health Center Program legislative and regulatory requirements. HRSA intends to make the following changes to its forms:Modify the following forms to streamline and clarify data currently being collected: 1A, 1C, 2, 3, 3A, 4, 5A, 5C, 6A, 8, 12, Health Center Controlled Networks (HCCN) Progress Report, Program Specific Forms Instructions, Project Narrative Update (Budget Period Progress Report [BPR]), Project Work Plan, and the Summary Page. Rename Substance Abuse Progress Report to Health Center Program Progress Report. Add the following forms necessary for funding applications and program monitoring: Capital Semi-Annual Progress Report, HCCN Participating Health Center List, Loan Guarantee Application, Patient Target Question Verification, Project Plan, and Substance Use Disorder and Mental Health Services (SUD-MH) Supplemental Funding Progress Report. Remove the following forms to further streamline information collected by HRSA and reduce burden: Alterations and Renovations Project Cover Page, Form 9: Need for Assistance, Form 10: Annual Emergency Preparedness Report, HCCN Work Plan, Outreach and Enrollment Supplemental, and Zika Progress Report. Likely Respondents: Health Center Program award recipients (those funded under section 330 of the PHS Act) and Health Center Program 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 ICR are summarized in the table below. Total Estimated Annualized Burden Hours ---------------------------------------------------------------------------------------------------------------- Average Number of Number of Total burden per Total burden Form name respondents responses per responses response (in hours respondent hours) ---------------------------------------------------------------------------------------------------------------- Capital Semi-Annual Progress 996 1 996 1.00 996 Report (New)................... Checklist for Adding a New 450 1 450 1.00 450 Service........................ Checklist for Adding a New 1,480 1 1,480 1.50 2,220 Service Delivery Site.......... Checklist for Adding a New 100 1 100 0.50 50 Target Population.............. Checklist for Deleting an 500 1 500 1.00 500 Existing Service............... [[Page 13938]] Checklist for Deleting an 500 1 500 1.00 500 Existing Service Delivery Site. Clinical Performance Measures... 1,058 1 1,058 3.50 3,703 Equipment List.................. 1,375 1 1,375 1.00 1,375 Expanded Services Project 1,058 1 1,058 1.00 1,058 Narrative)..................... Federal Object Class Categories. 735 1 735 0.25 184 Financial Performance Measures.. 1,058 1 1,058 1.00 1,058 Form 1A: General Information 1,058 1 1,058 1.00 1,058 Worksheet...................... Form 1B: BPHC Funding Request 1,000 1 1,000 0.75 750 Summary........................ Form 1C: Documents on File...... 1,058 1 1,058 0.50 529 Form 2: Staffing Profile........ 1,058 1 1,058 1.00 1,058 Form 3: Income Analysis......... 1,058 1 1,058 2.50 2,645 Form 3A: Look-Alike Budget 50 1 50 1.00 50 Information.................... Form 4: Community 1,058 1 1,058 1.00 1,058 Characteristics................ Form 5A: Services Provided...... 1,058 1 1,058 1.00 1,058 Form 5B: Service Sites.......... 1,508 1 1,508 0.75 1,131 Form 5C: Other Activities/ 1,058 1 1,058 0.50 529 Locations...................... Form 6A: Current Board Member 1,058 1 1,058 0.50 529 Characteristics................ Form 6B: Request for Waiver of 1,058 1 1,058 1.00 1,058 Governance Requirements........ Form 8: Health Center Agreements 1,058 1 1,058 0.75 794 Form 12: Organization Contacts.. 1,058 1 1,058 0.50 529 Funding Sources................. 735 1 735 0.50 368 HCCN Participating Health Center 90 1 90 1.00 90 List (NEW)..................... HCCN Progress Report............ 90 1 90 25.00 2,250 Health Center Program Progress 735 1 735 1.00 735 Report (previously Substance Abuse Progress Report)......... Loan Guarantee Application (NEW) 20 1 20 1.00 20 Operational Plan Instructions... 500 1 500 3.00 1,500 Other Requirements for Sites.... 600 1 600 0.50 300 Patient Target Question 1,058 1 1,058 1.00 1,058 Verification (NEW)............. Program Specific Form 1,500 1 1,500 1.00 1,500 Instructions................... Project Cover Page.............. 735 1 735 1.00 735 Project Narrative Update (BPR).. 883 1 883 4.00 3,532 Project Plan (NEW).............. 1,300 1 1,300 1.00 1,300 Project Qualification Criteria.. 735 1 735 1.00 735 Project Work Plan............... 135 1 135 5.00 675 Proposal Cover Page............. 735 1 735 1.00 735 SUD-MH Supplemental Funding 1,375 1 1,375 1.00 1,375 Progress Report (NEW).......... Summary Page.................... 1,008 1 1,008 0.25 252 Supplemental Information........ 500 1 500 1.00 500 ------------------------------------------------------------------------------- Total Hours................. 35,790 .............. 35,790 .............. 42,530 ---------------------------------------------------------------------------------------------------------------- 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. Amy P. McNulty, Acting Director, Division of the Executive Secretariat. [FR Doc. 2019-06766 Filed 4-5-19; 8:45 am] BILLING CODE 4165-15-P