Evaluation and Initial Assessment of HRSA Teaching Health Centers

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 4 THC Graduation Survey	Form and Instruction	Modified	Available
Form 3 THC Matriculant Survey	Form and Instruction	Modified	Available
Form 2 THC Alumni Survey	Form and Instruction	Modified	Available
Form 1 Program Data Collection Tool	Form and Instruction	Modified	Available
Supporting Statement A THC Eval 11-29-16_clean.docx	Supporting Statement A	Uploaded 2016-12-28	Available
OMB Survey Question Mapping.xlsx	Supplementary Document	Uploaded 2016-12-28	Available
OMB Supporting Statement B THC Eval 11-29-16_clean.docx	Supporting Statement B	Uploaded 2016-12-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
208627	THC Graduation Survey	Form and Instruction	Modified
208626	THC Matriculant Survey	Form and Instruction	Modified
208625	THC Alumni Survey	Form and Instruction	Modified
208624	Program Data Collection Tool	Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0376	ICR Reference No: 201612-0915-005
Status: Historical Active	Previous ICR Reference No: 201309-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No: 20464
Title: Evaluation and Initial Assessment of HRSA Teaching Health Centers
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: 03/29/2017
	Date Received in OIRA: 12/28/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2020	36 Months From Approved	03/31/2017
Responses	610	0	645
Time Burden (Hours)	246	0	526
Cost Burden (Dollars)	0	0	0

---

Abstract: The Teaching Health Center Graduate Medical Education (THCGME) program under Section 340H of the Public Health Service Act (PHSA) supports the expansion of new and existing primary care residency training programs in community-based settings. The primary goals of this program are to increase the production of primary care doctors who are well prepared to practice in community settings, particularly with underserved populations, and to improve the overall number and geographic distribution of primary care providers. The statute specifically requires that Teaching Health Center Graduate Medical Education residency programs report annually on the types of primary care residents trained, the number trained, the number who complete residency, the number who care for vulnerable populations and any other information as deemed appropriate by the Secretary. In order to comply with the law and ensure goals and reporting requirements of the THCGME program are met, four data collection instruments have been developed to collect information from each THC program and their residents: 1) Program Data Collection Tool, 2) THC Matriculant Survey, 3) THC Graduate Survey, and 4) THC Alumni Survey.

---

Authorizing Statute(s): US Code: 42 USC 256H Name of Law: Program of Payments to Teaching Health Centers that Operate Graduate Medical Education Programs
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 71108	10/14/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 95620	12/28/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
THC Alumni Survey	2	Alumni Survey
Program Data Collection Tool	1	Program Data Collection Tool
THC Matriculant Survey	3	Matriculation Survey
THC Graduation Survey	4	Graduation Survey

---

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	610	645	0	-35	0	0
Annual Time Burden (Hours)	246	526	0	-280	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Cutting Redundancy

Short Statement: A reduction in the number of residents supported by the THCGME program as well as awardees dropping out of the program for various reasons are responsible for the change in number of respondents.

---

Annual Cost to Federal Government: $46,000

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]? Yes

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

---

Common Form ICR:  No

---

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: 12/28/2016

---