Standardized Work Plan (SWP) Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 2 QPU w Instructions and Burden Statement.pdf	Form and Instruction	New	Available
Form 2 Quarterly Progress Update (QPU) Form	Form and Instruction	New	Repair queued
Form 1 SWP w Instructions and Burden Statement.pdf	Form and Instruction	Modified	Available
Form 1 Standardized Work Plan (SWP) Form	Form and Instruction	Modified	Repair queued
Supporting Statement A BHW Standardized Work Plan Revision - Final.docx	Supporting Statement A	Uploaded 2020-12-03	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
244748	Quarterly Progress Update (QPU) Form	Form and Instruction	New	QPU w Instructions and Burden Statement.pdf
244748	Quarterly Progress Update (QPU) Form	Form and Instruction	New
238619	Standardized Work Plan (SWP) Form	Form and Instruction	Modified	SWP w Instructions and Burden Statement.pdf
238619	Standardized Work Plan (SWP) Form	Form and Instruction	Modified

ICR Details

OMB Control No: 0906-0049	ICR Reference No: 202012-0906-001
Status: Historical Active	Previous ICR Reference No: 201911-0906-002
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Standardized Work Plan (SWP) Form
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/01/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/14/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2024	36 Months From Approved	02/28/2023
Responses	5,000	0	1,000
Time Burden (Hours)	1,400	0	1,000
Cost Burden (Dollars)	0	0	0

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Abstract: BHW requires applicants for awards to submit a work plan that describes the timeframes and deliverables via the Standardized Work Plan (SWP) form. Applicants submit SWP forms and award recipients and Project officers use the SWP to assist in monitoring progress once HRSA makes the awards. BHW proposes a revision to include a Quarterly Progress Update (QPU) for award recipients to provide information to BHW on a quarterly basis on each activity listed in the SWP.

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Authorizing Statute(s): US Code: 42 USC 254q-1, 295n-1(a)-(b), 296a(a) 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:
	85 FR 57221	09/15/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 80121	12/11/2020
Did the Agency receive public comments on this ICR? No

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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
Quarterly Progress Update (QPU) Form	2	QPU w Instructions and Burden Statement.pdf
Standardized Work Plan (SWP) Form	1	SWP w Instructions and Burden Statement.pdf

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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	5,000	1,000	0	4,000	0	0
Annual Time Burden (Hours)	1,400	1,000	0	400	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: A form has been added to this revised ICR, increasing the burden by 400 hours.

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Annual Cost to Federal Government: $9,124

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: 12/14/2020

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