CERTIFICATION OF OWNERSHIP AND USE STATUS OF HILL-BURTON AIDED FACILITIES

Forms and Documents

Document	Type	Status	Availability

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Collection	Type	Status	Form
110248	CERTIFICATION OF OWNERSHIP AND USE STATUS OF HILL-BURTON AIDED FACILITIES		Migrated

ICR Details

OMB Control No: 0915-0078	ICR Reference No: 198309-0915-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: CERTIFICATION OF OWNERSHIP AND USE STATUS OF HILL-BURTON AIDED FACILITIES
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/19/1983
	Date Received in OIRA: 09/27/1983
Terms of Clearance: THIS COLLECTION IS APPROVED ON THE CONDITION THAT A QUESTION IS ADDED TO THIS FORM REQUIRING THAT THE RESPONDENT SUPPLY THE DATE ON WHICH THE FACILITY FIRST OPENED FOR SERVICE AND SUPPORTING DOCUMENTATION. STEPS SHOULD BE TAKEN TO COMPARE THIS INFORMATION WITH BHMORD RECORDS TO DETERMINE WHETHER: 1] BHMORD RECORDS IN THIS REGARD ARE FACTUALLY CORRECT AND 2] INCORRECT REDUCTIONS OF UNCOMPENSATED CARE OBLIGATIONS HAVE OCCURRED. HHS SHALL REPORT RESULTS OF THIS COMPARISON TO OMB BY SEPTEMBER 30, 1984. THE LETTER TO THE RESPONDENT SHOULD ALSO REFER TH RESPONDENT TO THE FACILITY REPORT FOR THE GRANT NUMBER. HHS SHALL ALS ATTACH SECTIONS OF THE DRAFT RECOVERY MANUAL WHICH PROVIDES CRITERIA FOR DETERMINING WHETHER A MANAGEMENT CONTRACT CONSTITUTES A CHANGE IN CONTROL.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/1984	07/31/1984
Responses	1,500	0	0
Time Burden (Hours)	375	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: THE HILL-BURTON PROGRAM PROVIDED GRANT SUPPORT FOR CONSTRUCTING AND MODIFYING HEALTH FACILITIES DURING THE PERIOD 1946-1974. THIS SURVEY OF 1,500 GRANTEES IN SIX HHS REGIONS WILL DETERMINE IF UNAPPROVED CHANGES IN FACILITIES CONTROL OR USE DURING A 20-YEAR PERIOD OF INCURR SERVICE OBLIGATION OCCURRED.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
CERTIFICATION OF OWNERSHIP AND USE STATUS OF HILL-BURTON AIDED FACILITIES

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,500	0	0	1,500	0	0
Annual Time Burden (Hours)	375	0	0	375	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/27/1983

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