1995 Short-term, General, and Other Special Hospital Civil Rights Compliance Report and Hill-Burton Community Service Assurance Report for Triennial V

Forms and Documents

Forms and supporting documents for this ICR

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IC ID	Collection	Type	Status	Form
116778	1995 Short-term, General, and Other Special Hospital Civil Rights Compliance Report and Hill-Burton Community Service Assurance Report for Triennial V	Form	Migrated

ICR Details

OMB Control No: 0990-0209	ICR Reference No: 199506-0990-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: 1995 Short-term, General, and Other Special Hospital Civil Rights Compliance Report and Hill-Burton Community Service Assurance Report for Triennial V
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: 09/22/1995
	Date Received in OIRA: 06/30/1995
Terms of Clearance: This survey is approved for: 1) the universe of hospitals that have received Hill-Burton assistance; and 2) a targeted subset of the remaining short-term, general, and other special hospitals which will serve as an "operational" pilot of OCR's broader Civil Rights Act survey. In selecting a targeted subset of hospitals, OCR shall develop a valid methodology based on factors most likely to demonstrate a high risk of noncompliance with the Civil Rights Act of 1964. A reasonable subset of hospitals may include entities where significant complaint histories and high bed occupancy rates are correlated over time. OCR should coordinate with other HHS components (e.g. NCHS/PHS) to identify data supporting its metho- dology and subset selections. Prior to fielding the pilot, OCR shall share the methodology for the targeted subset with OMB for its concurrence that the methodology will produce valid and reliable data that will have utility. In the next submission for OMB review, OCR shall present an analysis of the cost-effectiveness of its targeted subset methodology and its overall civil rights enforcement strategy. This analysis should include historic trend analyses of civil rights outcomes relative to OCR actions, public complaints, and other appropriate variables, and should include statistical relationships. Such an analysis must be performed to refine the targeted subset approach or expand the efforts to the remaining hospitals subject to Title VI of the Civil Rights Act.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/1996	09/30/1996
Responses	1,659	0	0
Time Burden (Hours)	53,918	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Short-term, general, and other special hospitals that are recipients of DHHS funds are being requested to file a report providing information on their compliance with civil rights requirements. Those hospitals that received Hill-Burton assistance will also simultaneously fulfill triennial V community service reporting requirements by filing this report.

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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
1995 Short-term, General, and Other Special Hospital Civil Rights Compliance Report and Hill-Burton Community Service Assurance Report for Triennial V	503, 541

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ICR Summary of Burden

table that charts list 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	1,659	0	0	1,659	0	0
Annual Time Burden (Hours)	53,918	0	0	53,918	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: 06/30/1995

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