Uniform Data System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 2 EHR Question	Form and Instruction	Modified	Available
Form 1 2014 Tables	Form and Instruction	Modified	Available
Form T6B T6B	Form and Instruction	Modified	Available
Form T4 T4	Form and Instruction	Modified	Available
Form App D App D	Form and Instruction	Modified	Available
Form T6A T6A	Form and Instruction	Modified	Available
Form T7 T7	Form and Instruction	Modified	Available
Form 1 UDS Manual	Form and Instruction	Modified	Available
Lipid therapy rationale 121113.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2013-12-11	Available
FINAL Supporting_Statement A_0915-0193_11 09 2011.doc	Supporting Statement A	Uploaded 2013-12-11	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6420	Uniform Data System	Form and Instruction	Modified	EHR Question
6420	Uniform Data System	Form and Instruction	Modified	2014 Tables
6420	Uniform Data System	Form and Instruction	Modified	T6B
6420	Uniform Data System	Form and Instruction	Modified	T4
6420	Uniform Data System	Form and Instruction	Modified	App D
6420	Uniform Data System	Form and Instruction	Modified	T6A
6420	Uniform Data System	Form and Instruction	Modified	T7
6420	Uniform Data System	Form and Instruction	Modified	UDS Manual

ICR Details

OMB Control No: 0915-0193	ICR Reference No: 201312-0915-002
Status: Historical Active	Previous ICR Reference No: 201310-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No: 21120
Title: Uniform Data System
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/19/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/12/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2015	02/28/2015	02/28/2015
Responses	1,287	0	1,287
Time Burden (Hours)	111,438	0	111,438
Cost Burden (Dollars)	254,826	0	254,826

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Abstract: The Uniform Data System (UDS) is the Bureau of Primary Health Care's annual reporting system for grantees. The UDS includes reporting requirements for grantees of the following programs: the Community Health Center program, the Migrant Health Center program, the Health Care for the Homeless program, and other 330 funded grantees. The UDS is the tool that is used for monitoring and evaluating health center performance, and for ensuring compliance with legislative mandates.

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Authorizing Statute(s): PL: Pub.L. 107 - 251 1533 Name of Law: Health Care Safety Net Amendments
  

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

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
Uniform Data System	1, T7, T6A, App D, T4, T6B, 1, 2	UDS Manual ,   T7 ,   T6A ,   App D ,   T4 ,   T6B ,   2014 Tables ,   EHR Question

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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	1,287	1,287	0	0	0	0
Annual Time Burden (Hours)	111,438	111,438	0	0	0	0
Annual Cost Burden (Dollars)	254,826	254,826	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $800,000

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: 12/12/2013

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