[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]


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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.

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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
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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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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
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    Total Hours.................          35,790  ..............          35,790  ..............          42,530
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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