Rural Community Wealth and Health Care Provision Survey (RCWHCPS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Nonsub_Change_Memo_SRCWHCP_2-5-15.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-02-19	Available
Annex G_Key informant interview questions_revised_10-14.docx	Supplementary Document	Uploaded 2014-10-31	Available
Nonsub_Change_Memo_SRCWHCP_10-14.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-10-31	Available
Rural Community Pilot Repor_final_10212014.docx	Supplementary Document	Uploaded 2014-10-27	Available
Annex L_Sample size calculation (4).docx	Supplementary Document	Uploaded 2014-01-23	Available
ICR_Section A_revised 10-14.docx	Supporting Statement A	Uploaded 2014-10-31	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	Available
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	Available
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
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	Modified
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	Modified
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: 201502-0536-001
Status: Historical Active	Previous ICR Reference No: 201410-0536-001
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: 03/04/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/19/2015
Terms of Clearance: Previous terms of clearance remain in effect, as relevant.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2017	01/31/2017	01/31/2017
Responses	3,209	0	2,850
Time Burden (Hours)	2,187	0	2,198
Cost Burden (Dollars)	0	0	0

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Abstract: ERS requests making non-substantive changes for sampling approach and recruitment protocol in the full study of the health care provider component of the Rural Community Wealth and Health Care Provision Survey (RCWHCPS).

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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

table that charts list of burden

IC Title	Form No.	Form Name
Survey on Rural Community Wealth and Health Care Provision - Focus group_nonrespondents
Survey on Rural Community Wealth and Health Care Provision - Focus group_respondents
Survey on Rural Community Wealth and Health Care Provision - Key Informant Telephone Interviews_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_nonrespondents
Survey on Rural Community Wealth and Health Care Provision - Mail/web survey with health care providers_respondents

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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	3,209	2,850	0	359	0	0
Annual Time Burden (Hours)	2,187	2,198	0	-11	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The requested increase in the number of health care providers sample in each community from 10 to 32 will result in an estimated increase of 359 in the total number of respondents. Our revision for the expected survey response rate from 80% to 30% based on our pilot study results is the reason for a reduced burden hours.

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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: 02/19/2015

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