Rural Community Wealth and Health Care Provision Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Annex L_Sample size calculation (4).docx	Supplementary Document	Uploaded 2014-01-23	Available
ICR_Section A_11122013.docx	Supporting Statement A	Uploaded 2013-11-12	Available
Annex H_Advance letters and brochure.docx	Supplementary Document	Uploaded 2013-10-29	Available
Annex K_Federal Register notice.docx	Supplementary Document	Uploaded 2013-10-29	Repair queued
Annex J_Formulas for estimating means and variances.docx	Supplementary Document	Uploaded 2013-10-25	Available
Annex I_Health care facilities in the sample communities.docx	Supplementary Document	Uploaded 2013-10-25	Available
Annex E_Cognitive interview report.docx	Supplementary Document	Uploaded 2013-10-25	Available
Annex D_Technical Review Panel meeting report.docx	Supplementary Document	Uploaded 2013-10-25	Available
Annex C_Letter from Thomas Morris.docx	Supplementary Document	Uploaded 2013-10-25	Repair queued
Annex B_Experts consulted.docx	Supplementary Document	Uploaded 2013-10-25	Available
Annex A_References.docx	Supplementary Document	Uploaded 2013-10-25	Available
ICR_Section B_1-14.docx	Supporting Statement B	Uploaded 2014-01-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202492	Survey on Rural Community Wealth and Health Care Provision - community leaser nonrespondents in full study	Other-Advance letter, disclosures, & brochure	Removed
202491	Survey on Rural Community Wealth and Health Care Provision - community leaser respondents in full study	Other-Community Leader questionnaie in full study	Removed
202490	Survey on Rural Community Wealth and Health Care Provision - health care provider nonrespondents in full study	Other-Advance letter, disclosures, & brochure for full study	Removed
202489	Survey on Rural Community Wealth and Health Care Provision - health care provider respondents in full study	Other-Health Care Provider Questionnaire for full study	Removed
202488	Survey on Rural Community Wealth and Health Care Provision - community leader nonrespondents in pilot study	Other-Advance letter, disclosures, & brochure for pilot study	Removed
202487	Survey on Rural Community Wealth and Health Care Provision - nonrespondents in full study screening	Other-Screen Script for full study	Removed
202486	Survey on Rural Community Wealth and Health Care Provision - Focus group_nonrespondents	Other-Non-response place holder_focus group	Modified
202485	Survey on Rural Community Wealth and Health Care Provision - Mail/web survey with health care providers_nonrespondents	Other-Nonresponse place holder_mail questionnaire	Modified
202484	Survey on Rural Community Wealth and Health Care Provision - Key Informant Telephone Interviews_nonrespondents	Other-Non-response place holder	Modified
202483	Survey on Rural Community Wealth and Health Care Provision - Focus group_respondents	Other-Place Holder for Focus Group	Modified
202481	Survey on Rural Community Wealth and Health Care Provision - Mail/web survey with health care providers_respondents	Other-Questionnaire	Modified
202475	Survey on Rural Community Wealth and Health Care Provision - Key Informant Telephone Interviews_respondents	Other-Key Informant Semi-Structured Interview	Modified

ICR Details

OMB Control No: 0536-0072	ICR Reference No: 201310-0536-001
Status: Historical Active	Previous ICR Reference No: 201205-0536-002
Agency/Subagency: USDA/ERS	Agency Tracking No:
Title: Rural Community Wealth and Health Care Provision Survey
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: 01/23/2014
	Date Received in OIRA: 11/13/2013
Terms of Clearance: Agency agrees to submit pilot study status reports to OMB prior to launch of main study. Any need for further review as the result of subsequent changes will be discussed at that time.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2017	36 Months From Approved
Responses	2,850	0	0
Time Burden (Hours)	2,198	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This survey will collect information on the assets and investments of rural communities and their influence on recruitment and retention of rural health care providers, and on the effects of rural health care provision on economic development of rural communities. This information will contribute to a better understanding of the roles that rural communities play in promoting or retarding the provision of health care services, and of how improved health care provision contributes to development of these communities.

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Authorizing Statute(s): US Code: 7 USC 2204 Name of Law: General duties of Secretary; Advisory functions; research and development
   US Code: 7 USC 2661 Name of Law: Statement of purposes and goals
  

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:
	78 FR 116	06/17/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 219	11/13/2013
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Survey on Rural Community Wealth and Health Care Provision - Key Informant Telephone Interviews_respondents
Survey on Rural Community Wealth and Health Care Provision - community leaser respondents in full study
Survey on Rural Community Wealth and Health Care Provision - Mail/web survey with health care providers_respondents
Survey on Rural Community Wealth and Health Care Provision - Focus group_respondents
Survey on Rural Community Wealth and Health Care Provision - community leaser nonrespondents in full study
Survey on Rural Community Wealth and Health Care Provision - nonrespondents in full study screening
Survey on Rural Community Wealth and Health Care Provision - community leader nonrespondents in pilot study
Survey on Rural Community Wealth and Health Care Provision - health care provider respondents in full study
Survey on Rural Community Wealth and Health Care Provision - health care provider nonrespondents in full study
Survey on Rural Community Wealth and Health Care Provision - Key Informant Telephone Interviews_nonrespondents
Survey on Rural Community Wealth and Health Care Provision - Mail/web survey with health care providers_nonrespondents
Survey on Rural Community Wealth and Health Care Provision - Focus group_nonrespondents

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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	2,850	0	0	4,830	-1,980	0
Annual Time Burden (Hours)	2,198	0	0	3,010	-812	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 new information collection. The numbers in the adjustment column are due to the removal of unnecessary ICs.

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Annual Cost to Federal Government: $242,975

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 11/13/2013

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