IHS Urban Indian Health Program Common Reporting Requirements

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0917-0007 IHS Urban Indian Health Program Common Reporting Requirements	Form and Instruction	Modified	Available
60_Day_FR_Notice_OUIHP_11-18-09[1].pdf	Supplementary Document	Uploaded 2010-11-16	Repair queued
30_DAY_NOTICE_OUIHP_5-23-2011-_final.doc	Supplementary Document	Uploaded 2011-05-23	Repair queued
30_DAY_NOTICE_OUIHP_6-29-2011-_final.doc	Supplementary Document	Uploaded 2011-06-29	Available
Urban_Programs_Manual_Supporting_Statement_6-29-11final1.docx	Supplementary Document	Uploaded 2011-06-29	Available
Urban_Programs_Manual_Supporting_Statement_8-5-11final.docx	Supporting Statement A	Uploaded 2011-08-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6565	IHS Urban Indian Health Program Common Reporting Requirements	Form and Instruction	Modified

ICR Details

OMB Control No: 0917-0007	ICR Reference No: 201108-0917-001
Status: Historical Active	Previous ICR Reference No: 200408-0917-001
Agency/Subagency: HHS/IHS	Agency Tracking No:
Title: IHS Urban Indian Health Program Common Reporting Requirements
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/23/2011
	Date Received in OIRA: 08/08/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2014	36 Months From Approved
Responses	33	0	0
Time Burden (Hours)	792	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Information required to assess the quality of healthcare services, and are likely already familiar to, and may already be in use by UIHP grantees.

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Authorizing Statute(s): PL: Pub.L. 94 - 437 507 Name of Law: Indian Health Care Improvement 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:
	74 FR 59544	11/18/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 65357	10/22/2010
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
IHS Urban Indian Health Program Common Reporting Requirements	0917-0007	UDS Reporting Instructions for OUIHP Programs

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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	33	0	0	33	0	0
Annual Time Burden (Hours)	792	0	0	792	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: The former estimated burden was 515 hours for the UCRR reporting. The UDS will increase the burden to approximately 792 hours, for an overall increase of 177 hours. The change is due to the following: 1) the majority for the programs have not used the UDS reporting and will require training to complete the UDS report; and 2) tables in the UDS report were not reported on the UCRR.

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Annual Cost to Federal Government: $274,729

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]? No

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: 08/08/2011

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