Rural Health Community-Based Grant Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form rh5 rh5	Form and Instruction	New	Available
Form rh4 rh4	Form and Instruction	New	Available
Form rh3 rh3	Form and Instruction	New	Available
Form rh2 rh2	Form and Instruction	New	Available
Form rh1 rh1	Form and Instruction	New	Available
orhp nac charter.doc	Supplementary Document	Uploaded 2008-02-22	Available
orhp nac report.pdf	Supplementary Document	Uploaded 2008-02-22	Available
ss OHRP.doc	Supporting Statement A	Uploaded 2008-05-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
184013	Network Development Planning Grant Program	Instruction	New
184013	Network Development Planning Grant Program	Form and Instruction	New	rh5
184012	Small Health Care Provider Quality Improvement Grant Program	Instruction	New
184012	Small Health Care Provider Quality Improvement Grant Program	Form and Instruction	New	rh4
184011	Delta States Rural Development Network Grant Program	Instruction	New
184011	Delta States Rural Development Network Grant Program	Form and Instruction	New	rh3
184010	Rural Health Network Development	Instruction	New
184010	Rural Health Network Development	Form and Instruction	New	rh2
184009	Rural Health Outreach Grant Program	Instruction	New
184009	Rural Health Outreach Grant Program	Form and Instruction	New	rh1

ICR Details

OMB Control No: 0915-0319	ICR Reference No: 200803-0915-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Rural Health Community-Based Grant 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: Approved with change	Conclusion Date: 05/20/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/04/2008
Terms of Clearance: This submission is approved with change. Minor revisions were made to the supporting statement, as well as to the survey instrument, to reflect the change (decrease)in burden hours associated with this collection. Minor formatting changes were also made to the survey instrument to make it more user friendly.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2011	36 Months From Approved
Responses	191	0	0
Time Burden (Hours)	353	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: HRSA's Office of Rural Health Policy has developed a Performance Improvement and Measurement System (PIMS)for the collection of information on grant activities and performance measures for five rural health community-based grant programs. These grant programs provide support for sustaining and improving access to quality health care services in rural communities.

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Authorizing Statute(s): PL: Pub.L. 107 - 251 201 Name of Law: Health Care Safety Amendments of 2002
   US Code: 42 USC 254c Name of Law: Rural Health Outreach Grant Program
   US Code: 42 USC 254c Name of Law: Rural Health Network Development Program
  

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 45821	08/15/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 9342	02/20/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Delta States Rural Development Network Grant Program	rh3	rh3
Network Development Planning Grant Program	rh5	rh5
Rural Health Network Development	rh2	rh2
Rural Health Outreach Grant Program	rh1	rh1
Small Health Care Provider Quality Improvement Grant Program	rh4	rh4

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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	191	0	0	191	0	0
Annual Time Burden (Hours)	353	0	0	353	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: This new data collection activity is a program change resulting in an increase in agency burden due to the need for performance measures and grant monitoring for five rural health grant programs. These grant programs provide support for a variety of activities aimed at sustaining and improving health care services in rural communities, and the information is needed to ensure progress towards those goals.

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Annual Cost to Federal Government: $11,069

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: 03/04/2008

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