Health Care and Other Facilities Project Status Update Form

Forms and Documents

Document Name	Status
Form Project Status Upd Health Care and Other Facilities Project Status Update Form- Equipment Only Form	New
Form Project Status Upd Health Care and Other Facilities Project Status Update Form- Construction Related Form	New
guidancehrsa05144.pdf Supplementary Document	2007-07-02
FINAL HCOF SS Rev DFCR May 30 2007.doc Supporting Statement A	2007-07-02

IC Document Collections

IC ID	Document Title	Status
181198	Health Care and Other Facilities Project Status Update Form- Equipment Only Form	New
181197	Health Care and Other Facilities Project Status Update Form- Construction Related Form	New

ICR Details

OMB Control No: 0915-0309	ICR Reference No: 200707-0915-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Health Care and Other Facilities Project Status Update Form
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: 10/12/2007
	Date Received in OIRA: 07/13/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2010	36 Months From Approved
Responses	2,103	0	0
Time Burden (Hours)	1,052	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: HRSA is requesting approval for the Health Care and Other Facilities Project Status Update Form. This form will allow for the standardized and electronic collection of information that will allow HRSA to monitor and verify its grantees' progress towards completion of their projects.

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Authorizing Statute(s): US Code: 42 USC 1627 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 5445	02/06/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 37248	07/09/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Health Care and Other Facilities Project Status Update Form- Construction Related	Project Status Update Form	Project Status Update Form
Health Care and Other Facilities Project Status Update Form- Equipment Only	Project Status Update Form	Project Status Update Form

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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	2,103	0	0	2,103	0	0
Annual Time Burden (Hours)	1,052	0	0	1,052	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: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: HRSA's Health Care and Other Facilities program provides earmarked funds to health-related facilities for construction-related activities and/or capital equipment purchases. Awarded facilities are required to provide a periodic update of the status of funded projects until they are completed. The proposed form will allow for the standardized and electronic collection of information so that HRSA can monitor and verify its grantees' progress towards completion of their projects.

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Annual Cost to Federal Government: $45,361

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: 07/13/2007

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