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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.