[Federal Register Volume 84, Number 248 (Friday, December 27, 2019)]
[Notices]
[Pages 71433-71435]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-27909]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Agency Information Collection Activities: Submission to OMB for 
Review and Approval; Public Comment Request; 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 of the Paperwork Reduction Act of 1995, 
HRSA has submitted an Information Collection Request (ICR) to the 
Office of Management and Budget (OMB) for review and approval. Comments 
submitted during the first public review of this ICR will be provided 
to OMB. OMB will accept further comments from the public during the 
review and approval period. OMB may act on HRSA's ICR only after the 30 
day comment period for this notice has closed.

DATES: Comments on this ICR should be received no later than January 
27, 2020.

ADDRESSES: Submit your comments, including the ICR Title, to the desk 
officer for HRSA, either by email to [email protected] or by 
fax to (202) 395-5806.

FOR FURTHER INFORMATION CONTACT: To request a copy of the clearance 
requests submitted to OMB for review, email Lisa Wright-Solomon, the 
HRSA Information Collection Clearance Officer at [email protected] or 
call (301) 443-1984.

SUPPLEMENTARY INFORMATION: 
    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.
    A 60-day notice was published in the Federal Register on April 8, 
2019, vol. 84, No. 67; pp. 13937-38. No public comments were received.
    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 several changes to its forms:
     HRSA will modify the following forms to streamline and 
clarify data (e.g., text changes, updated instructions) currently being 
collected: 1A, 1B, 1C, 2, 3, 3A, 4, 5A, 5B, 5C, 6A, 8, 12, Checklist 
for Adding a New Service, Checklist for Adding a New Service Delivery 
Site, Checklist for Adding a New Target Population, Checklist for 
Deleting Existing Service, Checklist for Deleting Existing Service 
Delivery Site, Clinical Performance Measures, Equipment List, Expanded 
Services, Federal Object Class Categories, Financial Performance 
Measures, Funding Sources, Health Center Controlled Networks (HCCN) 
Progress Report Table, Operational Plan, Program Specific Forms 
Instructions, Project Qualification Criteria, Project Work Plan, 
Proposal Cover Page, and the Summary Page.
     HRSA will rename the following forms: Substance Abuse 
Progress Report will be changed to Health Center Program Progress 
Report, Program Narrative Update will be changed to Project Narrative 
Update, and Outreach and Enrollment Supplemental form will be changed 
to Health Center Program: Supplemental Information.

[[Page 71434]]

     HRSA will add the following forms to collect information 
to support funding applications and program monitoring: Capital Semi-
Annual Progress Report, Diabetes Action Plan Quarterly Report Template, 
FY 2018 Expanding Access to Quality Substance Use Disorder and Mental 
Health Services (SUD-MH)/Integrated Behavioral Health Services (IBHS) 
Progress Reporting, FY2020 Ending the HIV Epidemic--Primary Care HIV 
Prevention Progress Reporting, HRSA Electronic Handbooks Action Plan, 
HRSA Loan Guarantee Program Application, Participating Health Center 
List, Patient Target and Calculations, Project Overview, and Project 
Plan.
     HRSA will 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, and Zika Progress 
Report.
    Since the submission of the 60-day Federal Register notice (FRN), 
there are 5 additional new forms (for a total of 10 new forms) due to 
new initiatives that required clearance (2 HIV funding-related forms, 2 
diabetes funding-related forms, and 1 HCCN funding-related form); the 
data needed for the new initiatives could not be captured in forms 
previously approved. Please note, the 60-day FRN included one form 
identified as ``new'' (Project Work Plan); however, that form was 
actually included in the previous OMB package submitted in 2017. The 
correction has been made in this 30-day FRN and this form is no longer 
listed as new in this documentation.
    The 60-day FRN request contained 42,530 burden hours. However, this 
final 30-day notice includes an additional 16,712 burden hours, for a 
new total of 59,242 burden hours.
    Likely Respondents: Health Center Program award recipients (those 
funded under section 330 of the PHS Act); Health Center Program look-
alikes; state and national trade associations; and other organizations 
seeking Health Center Program 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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                                                     Number of                    Average burden
            Form name                Number of     responses per       Total       per response    Total burden
                                    respondents     respondent       responses      (in hours)         hours
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Capital Semi-Annual Progress                 996               2           1,992            1.00           1,992
 Report (new)...................
Checklist for Adding a New                   450               1             450            2.00             900
 Service........................
Checklist for Adding a New                 1,480               1           1,480            2.00           2,960
 Service Delivery Site..........
Checklist for Adding a New                   100               1             100            2.00             200
 Target Population..............
Checklist for Deleting Existing              500               1             500            2.00           1,000
 Service........................
Checklist for Deleting Existing              750               1             750            2.00           1,500
 Service Delivery Site..........
Clinical Performance Measures...           1,058               1           1,058            3.50           3,703
Diabetes Action Plan--Quarterly            1,058               4           4,232            2.00           8,464
 Report Template (new)..........
Equipment List..................           1,375               1           1,375            1.00           1,375
Expanded Services...............             996               1             996            1.00             996
Federal Object Class Categories.             735               1             735            0.25             184
Financial Performance Measures..           1,058               1           1,058            1.50           1,587
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            1.00           1,058
Form 3A: FQHC 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            1.00           1,508
Form 5C: Other Activities/                 1,058               1           1,058            0.50             529
 Locations......................
Form 6A: Current Board Member              1,058               1           1,058            1.00           1,058
 Characteristics................
Form 6B: Request for Waiver of             1,058               1           1,058            1.00           1,058
 Board Member Requirements......
Form 8: Health Center Agreements           1,058               1           1,058            1.00           1,058
Form 12: Organization Contacts..           1,058               1           1,058            0.50             529
Funding Sources.................             735               1             735            0.50             368
FY2018 Expanding Access to                 1,375               3           4,125            1.00           4,125
 Quality SUD-MH/IBHS Progress
 Reporting (new)................
FY2020 Ending the HIV Epidemic--             182               1             182            1.00             182
 Primary Care HIV Prevention
 Progress Reporting (new).......
HCCN Progress Report Table......              90               1              90            1.00              90
Health Center Program Progress               735               1             735            1.00             735
 Report (previously Substance
 Abuse Progress Report).........
Health Center Program:                       500               1             500            1.00             500
 Supplemental Information
 (previously Outreach and
 Enrollment Supplemental Form)..
HRSA Electronic Handbooks Action           1,058               4           4,232            1.00           4,232
 Plan (new).....................
HRSA Loan Guarantee Program                   20               1              20            1.00              20
 Application (new)..............
Operational Plan................             500               1             500            3.00           1,500

[[Page 71435]]

 
Other Requirements for Sites....             600               1             600            0.50             300
Participating Health Center List              90               1              90            1.00              90
 (new)..........................
Patient Target and Calculations            1,058               1           1,058            1.00           1,058
 (new)..........................
Program Specific Forms                     1,500               1           1,500            1.00           1,500
 Instructions...................
Project Narrative Update                     883               1             883            4.00           3,532
 (previously Program Narrative
 Update)........................
Project Overview (new)..........             182               1             182            1.00             182
Project Plan (new)..............             182               3             546            1.50             819
Project Qualification Criteria..             735               1             735            1.00             735
Project Work Plan...............             135               1             135            4.00             540
Proposal Cover Page.............             735               1             735            1.00             735
Summary Page....................           1,558               1           1,558            0.50             779
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    Total Hours.................          37,605  ..............          48,063  ..............          59,242
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Maria G. Button,
Director, Executive Secretariat.
[FR Doc. 2019-27909 Filed 12-26-19; 8:45 am]
BILLING CODE 4165-15-P