Information Collection

Shortage Designation Management System

IC 219565 under ICR 201601-0906-001 · OMB 0906-0029.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0029 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SDMS Supplemental Information - Attachment D.docx	Instruction
SDMS Provider Management User Guide - Attachment E.pdf	Instruction
SDMS Mapping Tool User Guide - Attachment F.pdf	Instruction
SDMS Manual for Policies and Procedures - Attachment G.pdf	Instruction
SDMS Primary Care Office Portal User Guide - Attachment H.pdf	Instruction
HPSA Statute - Attachment A.pdf Statute A	IC Document
MUAP Statute - Attachment B.pdf Statute B	IC Document
HPSA Regulations - Attachment C.pdf Regulation C	IC Document
SDMS 60 Day FRN - Attachment I.pdf FRN 60 day I	IC Document
HRSA FOA PCSRCD - Attachment K.pdf FOA K	IC Document
HPSA FRN - Attachment L.pdf FRN Shortage Areas	IC Document

IC Title:

Shortage Designation Management System

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	SDMS Supplemental Information - Attachment D.docx	Yes	Yes	Fillable Fileable
Instruction	SDMS Provider Management User Guide - Attachment E.pdf	Yes	Yes	Fillable Fileable
Instruction	SDMS Mapping Tool User Guide - Attachment F.pdf	Yes	Yes	Fillable Fileable
Instruction	SDMS Manual for Policies and Procedures - Attachment G.pdf	Yes	Yes	Fillable Fileable
Instruction	SDMS Primary Care Office Portal User Guide - Attachment H.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 54

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,078	3,078
Annual IC Time Burden (Hours)	106,899	106,899
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Statute A	HPSA Statute - Attachment A.pdf	01/12/2016
Statute B	MUAP Statute - Attachment B.pdf	01/12/2016
Regulation C	HPSA Regulations - Attachment C.pdf	01/12/2016
FRN 60 day I	SDMS 60 Day FRN - Attachment I.pdf	01/12/2016
FOA K	HRSA FOA PCSRCD - Attachment K.pdf	01/12/2016
FRN Shortage Areas	HPSA FRN - Attachment L.pdf	01/12/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.