Teaching Health Center Graduate Medical Education (THCGME) Program Cost Evaluation

Forms and Documents

Document Name	Status
Form 1 Teaching Health Center Graduate Medical Education (THCGME) Program Cost Evaluation Form and Instruction	New
THC Instruction Guide OMB.docx Supplementary Document	2020-08-13
Email to THCGME Grantees - Appendix A in Supporting Statement B.docx Supplementary Document	2020-08-13
Appendix C IRB Outcome Letter.pdf Supplementary Document	2020-08-13
Appendix B 60-day FRN.pdf Supplementary Document	2020-08-13
FINAL Supporting Statement B.docx Supporting Statement B	2020-08-13
FINAL Supporting Statement A.docx Supporting Statement A	2020-08-13

IC Document Collections

IC ID	Document Title	Status
243169	Teaching Health Center Graduate Medical Education (THCGME) Program Cost Evaluation Form and Instruction	New

ICR Details

OMB Control No: 0906-0057	ICR Reference No: 202008-0906-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Teaching Health Center Graduate Medical Education (THCGME) Program Cost Evaluation
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/06/2020
	Date Received in OIRA: 08/13/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2023	36 Months From Approved
Responses	56	0	0
Time Burden (Hours)	560	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The THCGME program supports the expansion of new and existing primary care residency training programs in community-based settings. The current evaluation will provide a current and analytically robust estimate of how much it costs to train a resident in this training model.

---

Authorizing Statute(s): US Code: 42 USC 256h, Section 340H Name of Law: PHSA
  

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:
	85 FR 23975	04/20/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 49385	08/13/2020
Did the Agency receive public comments on this ICR? Yes

---

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

IC Title	Form No.	Form Name
Teaching Health Center Graduate Medical Education (THCGME) Program Cost Evaluation	1	Appendix A THCGME Costing Instrument FINAL.pdf

---

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	56	0	0	56	0	0
Annual Time Burden (Hours)	560	0	0	560	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: This is a new ICR, the burden has increased from zero (0).

---

Annual Cost to Federal Government: $878,655

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

---

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: 08/13/2020

---