Shortage Designation Management System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
HPSA FRN - Attachment N.pdf	Supplementary Document	Uploaded 2016-09-30	Available
BMISS Privacy Impact Assessment Form 2014 - Attachment M.pdf	Supplementary Document	Uploaded 2016-09-30	Available
HRSA FOA PCSRCD - Attachment L.pdf	Supplementary Document	Uploaded 2016-09-30	Available
SDMS Provider Management Import Tool User Guide - Attachment K.pdf	Supplementary Document	Uploaded 2016-09-30	Available
SDMS 60 Day FRN - Attachment I.pdf	Supplementary Document	Uploaded 2016-09-30	Available
SDMS Supporting Statement - Final_OMB.docx	Supporting Statement A	Uploaded 2017-05-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
219565	Shortage Designation Management System	Instruction	New

ICR Details

OMB Control No: 0906-0029	ICR Reference No: 201601-0906-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Shortage Designation Management System
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/30/2017
	Date Received in OIRA: 10/03/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2020	36 Months From Approved
Responses	3,078	0	0
Time Burden (Hours)	106,899	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The need and purpose of this information collection is to obtain information for the Shortage Designation Management System application. The information is used to consider a geographic area, population, or facility for a HPSA or MUA/P shortage designation. Respondents must submit an application to HRSA to obtain a shortage designation in their state. The application asks for national, state and local data required to determine the area, population, or facility’s eligibility for a shortage designation. The respondents for this information collection are State Primary Care Offices who seek to improve primary care service delivery and workforce availability in the State or territory to meet the needs of underserved populations.

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Authorizing Statute(s): US Code: 42 USC 254e Title III Section 332 Name of Law: Public Health Service Act as Amended by 42 USC
   US Code: 42 USC 254b Title III Section 330(b) Name of Law: Public Health Service Act as Amended by 42 USC
  

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:
	80 FR 18240	04/03/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 78236	12/16/2015
Did the Agency receive public comments on this ICR? Yes

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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
Shortage Designation Management System

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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	3,078	0	0	3,078	0	0
Annual Time Burden (Hours)	106,899	0	0	106,899	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: There is no increase as this is a new collection. The two instruments listed in the supporting statement are integrated in the three manuals listed in the IC, Attachments E, F, and G.

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Annual Cost to Federal Government: $420,079

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: 01/13/2016

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