COMMON REPORTING REQUIREMENTS FOR IHS COMMUNITY HEALTH REPRESENTATIVE PROGRAM

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Forms and supporting documents for this ICR

Document	Type	Status	Availability

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Information collection document groups

IC ID	Collection	Type	Status	Form
110315	COMMON REPORTING REQUIREMENTS FOR IHS COMMUNITY HEALTH REPRESENTATIVE PROGRAM		Migrated

ICR Details

OMB Control No:	ICR Reference No: 198706-0915-002
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: COMMON REPORTING REQUIREMENTS FOR IHS COMMUNITY HEALTH REPRESENTATIVE PROGRAM
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: Disapproved	Conclusion Date: 08/24/1987
	Date Received in OIRA: 06/23/1987
Terms of Clearance: THIS INFORMATION REQUEST IS DISAPPROVED BECAUSE IT DOES NOT APPEAR TO BE THE LEAST BURDENSOME APPROACH NECESSARY TO ACHIEVE THE PROGRAM OBJECTIVE. ALTHOUGH IHS HAS TERMED THIS A QUARTERLY REPORTING REQUIREMENT FOR EACH PROJECT, IT COULD BE VIEWED AS A DAILY REPORTING REQUIREMENT FOR EACH COMMUNITY HEALTH REPRESENTATIVE (CHR). EACH CHR IS REQUIRED TO REPORT HIS OR HER DAILY ACTIVITIES. THE CHRs ALSO ARE REQUIRED TO NUMERICALLY CODE ALL OF THEIR RESPONSES. INFACT, THESE REPORTS ENCOMPASS A LEVEL OF DETAIL RARELY JUSTIFIED UNDER THE PAPERWORK REDUCTION ACT. IHS SHOULD CONSIDER ALTERNATIVE REPORTING MECHANISMS THAT COULD SERVE THE SAME GOALS. POSSIBLE APPROACHES INCLUDE: REPORTING ON A CONTRACTOR BASIS RATHER THAN A PROJECT BASIS, USING A COMBINATION OF PROJECTED CHR ACTIVITIES AND RANDOM SAMPLING OF PARTICULAR DAYS' ACTIVITIES, AND AUDITING AS A MEANS TO VALIDATE LESS FREQUENT AND MORE REPRESENTATIVE REPORTING.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: COMMUNITY HEALTH REPRESENTATIVES REPORT FOR EACH PATIENT SERVED CODES FOR: SERVICE CATEGORY, SERVICE ACTIVITY, MINUTES SERVED, HEALTH PROBLEM, PATIENT'S AGE, PATIENT'S SEX REFERRED FROM, AND REFERRED TO. THIS INFORMATION IS USED FOR PROGRAM PLANNING, MANAGEMENT AND EVALUATION PURPOSES. THE REPORT IS SUBMITTED TO IHS ON A QUARTERLY BASIS.

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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

table that charts list of burden

IC Title	Form No.	Form Name
COMMON REPORTING REQUIREMENTS FOR IHS COMMUNITY HEALTH REPRESENTATIVE PROGRAM

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

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: 06/23/1987

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