Reconciliation Tool for the Teaching Health Centers Graduate Medical Education Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 THCGME Reconciliation Tool	Form	New	Available
Reconciliation_Tool_Instructions 052611.docx	Supplementary Document	Uploaded 2011-06-02	Repair queued
Reconciliation Tool - Statement A final 6 2 11.docx	Supporting Statement A	Uploaded 2011-06-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
197986	THCGME Reconciliation Tool	Form	New

ICR Details

OMB Control No: 0915-0342	ICR Reference No: 201106-0915-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Reconciliation Tool for the Teaching Health Centers Graduate Medical Education 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 without change	Conclusion Date: 08/10/2011
	Date Received in OIRA: 06/06/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2014	36 Months From Approved
Responses	51	0	0
Time Burden (Hours)	255	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Teaching Health Centers Graduate Medical Education (THCGME) is an initiative to promote primary care residency training in community-based settings. The THCGME model is one of many different training models supported by the Affordable Care Act to address the shortage in primary care health providers. The statute allows THCs to receive payments for both direct and indirect costs associated with training residents in community-based ambulatory patient care centers. The Reconciliation Tool will be used to collect information relating to the number of Full-Time Equivalents (FTE) supported with THCGME payments in order to reconcile costs for both direct and indirect costs.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 5508 Name of Law: Patient Protection and Affordable Care 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:
	76 FR 17423	03/29/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 30948	05/27/2011
Did the Agency receive public comments on this ICR? Yes

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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
THCGME Reconciliation Tool	1	Reconciliation Tool

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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	51	0	0	51	0	0
Annual Time Burden (Hours)	255	0	0	255	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 is a program change of a annual estimated 255 hours for Teaching Health Centers to report information related to the number of Full-Time Equivalent residents supported with THCGME payments in order to reconcile costs for both direct and indirect costs.

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Annual Cost to Federal Government: $8,903

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]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 06/06/2011

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