Rural Community Wealth and Health Care Provision Survey (RCWHCPS)

Forms and Documents

Document Name	Status
Annex G_Key informant interview questions_revised_10-14.docx Supplementary Document	2014-10-31
Nonsub_Change_Memo_SRCWHCP_10-14.docx Justification for No Material/Nonsubstantive Change	2014-10-31
Rural Community Pilot Repor_final_10212014.docx Supplementary Document	2014-10-27
Annex L_Sample size calculation (4).docx Supplementary Document	2014-01-23
ICR_Section A_revised 10-14.docx Supporting Statement A	2014-10-31
Annex H_Advance letters and brochure.docx Supplementary Document	2013-10-29
Annex K_Federal Register notice.docx Supplementary Document	2013-10-29
Annex J_Formulas for estimating means and variances.docx Supplementary Document	2013-10-25
Annex I_Health care facilities in the sample communities.docx Supplementary Document	2013-10-25
Annex E_Cognitive interview report.docx Supplementary Document	2013-10-25
Annex D_Technical Review Panel meeting report.docx Supplementary Document	2013-10-25
Annex C_Letter from Thomas Morris.docx Supplementary Document	2013-10-25
Annex B_Experts consulted.docx Supplementary Document	2013-10-25
Annex A_References.docx Supplementary Document	2013-10-25
ICR_Section B_1-14.docx Supporting Statement B	2014-01-23

IC Document Collections

IC ID	Document Title	Status
202486	Survey on Rural Community Wealth and Health Care Provision - Focus group_nonrespondents Other-Non-response place holder_focus group	Unchanged
202485	Survey on Rural Community Wealth and Health Care Provision - Mail/web survey with health care providers_nonrespondents Other-Nonresponse place holder_mail questionnaire	Unchanged
202484	Survey on Rural Community Wealth and Health Care Provision - Key Informant Telephone Interviews_nonrespondents Other-Non-response place holder	Unchanged
202483	Survey on Rural Community Wealth and Health Care Provision - Focus group_respondents Other-Place Holder for Focus Group	Unchanged
202481	Survey on Rural Community Wealth and Health Care Provision - Mail/web survey with health care providers_respondents Other-Questionnaire	Unchanged
202475	Survey on Rural Community Wealth and Health Care Provision - Key Informant Telephone Interviews_respondents Other-Key Informant Semi-Structured Interview	Unchanged

ICR Details

OMB Control No: 0536-0072	ICR Reference No: 201410-0536-001
Status: Historical Active	Previous ICR Reference No: 201310-0536-001
Agency/Subagency: USDA/ERS	Agency Tracking No:
Title: Rural Community Wealth and Health Care Provision Survey (RCWHCPS)
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: 10/31/2014
	Date Received in OIRA: 10/31/2014
Terms of Clearance:

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

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Abstract: ERS requests making non-substantive changes for minor wording revisions for several questions on the Key Informant questionnaire of the RCWHCPS based on pilot study results.

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

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

IC Title	Form No.	Form Name
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
Survey on Rural Community Wealth and Health Care Provision - Key Informant Telephone Interviews_respondents
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

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ICR Summary 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	2,850	0	0	0	0
Annual Time Burden (Hours)	2,198	2,198	0	0	0	0
Annual Cost Burden (Dollars)	0	0	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: 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: 10/31/2014

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