Shortage Designation Management System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form D SDMS Supplemental Information - Attachment D.docx	Form and Instruction	New	Available
Form G Manual for Policies and Procedures - Attachment G.pdf	Form and Instruction	Modified	Available
Form F PCO Designation Management User Guide - Attachment F.pdf	Form and Instruction	Modified	Available
Form E PCO Provider Management User Guide - Attachment E.pdf	Form and Instruction	Modified	Available
2019 Designated PC HPSA FRN - Attachment L.pdf	Supplementary Document	Uploaded 2020-05-14	Available
2019 Designated PC HPSA FRN - Attachment K.pdf	Supplementary Document	Uploaded 2020-05-14	Available
2019 Designated PC HPSA FRN - Attachment J.pdf	Supplementary Document	Uploaded 2020-05-14	Available
State PCO NOFO HRSA-2019 - 2024 FINAL - Attachment I.pdf	Supplementary Document	Uploaded 2020-05-14	Available
SDMS 60 OMB FRN - Attachment H.pdf	Supplementary Document	Uploaded 2020-05-14	Available
HPSA Regulations - Attachment C.pdf	Supplementary Document	Uploaded 2020-05-14	Available
MUAP Statute - Attachment B.pdf	Supplementary Document	Uploaded 2020-05-14	Available
HPSA Statute - Attachment A.pdf	Supplementary Document	Uploaded 2020-05-14	Available
SS A SDMS 0029 HRSA RESPONSE CLEAN.docx	Supporting Statement A	Uploaded 2020-06-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
241813	SDMS Application	Form and Instruction	New	SDMS Supplemental Information - Attachment D.docx
219565	Designation, Planning, and Preparation	Form and Instruction	Modified	Manual for Policies and Procedures - Attachment G.pdf
219565	Designation, Planning, and Preparation	Form and Instruction	Modified	PCO Designation Management User Guide - Attachment F.pdf
219565	Designation, Planning, and Preparation	Form and Instruction	Modified	PCO Provider Management User Guide - Attachment E.pdf

ICR Details

OMB Control No: 0906-0029	ICR Reference No: 202005-0906-001
Status: Historical Active	Previous ICR Reference No: 201601-0906-001
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Shortage Designation Management System
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/07/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/14/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2023	36 Months From Approved	07/31/2020
Responses	7,074	0	3,078
Time Burden (Hours)	38,664	0	106,899
Cost Burden (Dollars)	0	0	0

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Abstract: The need and purpose of this information collection is to obtain information from the State Primary Care Offices (PCO) via the Shortage Designation Management System (SDMS) for the review of geographic area, population, or facility Health Professional Shortage Area (HPSA) and Medically Underserved Area/Population (MUAP) designations. The application asks for national, state and local data required to determine the area, population, or facility’s eligibility for a shortage designation. The respondents for this information collection are State PCO who seek to improve primary care service delivery and workforce availability in the State or territory to meet the needs of underserved populations.

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Authorizing Statute(s): US Code: 42 USC 254e Title III Section 332 Name of Law: Public Health Service Act as Amended by 42 USC
   US Code: 42 USC 254b Title III Section 330(b) Name of Law: Public Health Service Act as Amended by 42 USC
  

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:
	85 FR 11094	02/26/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 27746	05/11/2020
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Designation, Planning, and Preparation	E, F, G	PCO Provider Management User Guide - Attachment E.pdf ,   PCO Designation Management User Guide - Attachment F.pdf ,   Manual for Policies and Procedures - Attachment G.pdf
SDMS Application	D	SDMS Supplemental Information - Attachment D.docx

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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	7,074	3,078	0	3,996	0	0
Annual Time Burden (Hours)	38,664	106,899	0	-68,235	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: Yes

Burden Reduction Due to: Using Information Technology

Short Statement: The increase in burden is due to an increase in the number of responses per respondent. The decrease in burden is due to the development of the SDMS. PCOs are no longer required to provide certain information as it is automatically populated in the system when they select the rational service area via the mapping tool in SDMS.

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Annual Cost to Federal Government: $7,953,177

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? No

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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: 05/14/2020

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