Health Center Controlled Networks Progress Reports

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Health Center Controlled Networks Progress Reports	Form and Instruction	Modified	Available
Annual Progress Report InstructionsTemplate Final.docx	Supplementary Document	Uploaded 2016-03-22	Available
Work Plan Instructional Aid FINAL.DOCX	Supplementary Document	Uploaded 2016-03-22	Available
FINALSupporting Statement Final 03.21.16.docx	Supporting Statement A	Uploaded 2016-03-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
205055	Health Center Controlled Networks Progress Reports	Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0360	ICR Reference No: 201603-0915-005
Status: Historical Active	Previous ICR Reference No: 201305-0915-006
Agency/Subagency: HHS/HSA	Agency Tracking No: 19701
Title: Health Center Controlled Networks Progress Reports
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/26/2016
	Date Received in OIRA: 03/24/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2019	36 Months From Approved	05/31/2016
Responses	86	0	60
Time Burden (Hours)	2,382	0	1,662
Cost Burden (Dollars)	0	0	0

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Abstract: The Health Center Controlled Networks (HCCN) respondents are HCCNs that are currently serving health centers and other safety net entities. The purpose of the information collection is to inform HRSA of: new technical assistance needs and evaluate the performance and outcome of the funding initiative; most accurate responses to Departmental inquiries regarding the program; and use the information to reports to Congress and other external agencies.

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Authorizing Statute(s): US Code: 42 USC 254(b) Name of Law: Public Health Service Act
  

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 140	07/22/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 44	03/07/2016
Did the Agency receive public comments on this ICR? No

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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
Health Center Controlled Networks Progress Reports	1, 2	Work Plan ,   Annual Progress Report

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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	86	60	0	26	0	0
Annual Time Burden (Hours)	2,382	1,662	0	720	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: The burden has been adjusted to reflect the number of anticipated responses. The forms have not been changed.

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Annual Cost to Federal Government: $406,667

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: 03/24/2016

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