Reconciliation Tool for the Teaching Health Center Graduate Medical Education (THCGME) Program

Forms and Documents

Document Name	Status
Form 1 Reconciliation Tool for the Teaching Health Center Graduate Medical Education Program Form and Instruction	Modified
THCGME Supporting Statement_rev 5-30-17.docx Supporting Statement A	2017-06-02

IC Document Collections

IC ID	Document Title	Status
197986	Reconciliation Tool for the Teaching Health Center Graduate Medical Education Program Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0342	ICR Reference No: 201706-0915-001
Status: Historical Active	Previous ICR Reference No: 201404-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Reconciliation Tool for the Teaching Health Center Graduate Medical Education (THCGME) Program
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: 07/19/2017
	Date Received in OIRA: 06/07/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2020	36 Months From Approved	07/31/2017
Responses	59	0	44
Time Burden (Hours)	118	0	88
Cost Burden (Dollars)	0	0	0

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Abstract: The THCGME program statute provides that eligible Teaching Health Centers receive payments for both direct and indirect costs associated with training residents in community-based ambulatory patient care centers. THCGME payments are prospective payments and the statute provides for a reconciliation process, through which overpayments may be recouped. This data collection tool will gather information relating to THCGME-supported resident FTEs in order to reconcile payments. The likely responders are existing THCGME awardees.

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Authorizing Statute(s): US Code: 42 USC Section 340H 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:
	82 FR 15229	03/27/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 26499	06/07/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Reconciliation Tool for the Teaching Health Center Graduate Medical Education Program	1	Attachment 1-THCGME Reconciliation Tool Form.docx

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ICR Summary 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	59	44	0	15	0	0
Annual Time Burden (Hours)	118	88	0	30	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 number of respondents has increased but the burden hours and number of responses has remained the same, hence submitting as an extension.

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Annual Cost to Federal Government: $8,503

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]? 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

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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: 06/07/2017

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