Health Center COVID-19 Vaccine Program

ICR 202102-0906-002

OMB: 0906-0062

Federal Form Document

Forms and Documents
ICR Details
Received in OIRA
Health Center COVID-19 Vaccine Program
New collection (Request for a new OMB Control Number)   No
Emergency 02/18/2021
  Requested Previously Approved
6 Months From Approved
134,708 0
100,690 0
0 0

The Health Resources and Services Administration (HRSA) is requesting an expedited review from the Office of Management and Budget (OMB) for two data collection tools critical for vaccine distribution to health centers for the Health Center COVID-19 Vaccine Program. The Readiness Assessment – a one-time tool to collect data on the readiness and interest of HRSA-funded health centers preliminarily identified by CDC and HRSA to receive a direct allocation of a limited supply of COVID-19 vaccines, and the weekly COVID-19 Data Collection Survey Tool with an Addendum for health centers participating in the Program are essential to help track vaccine needs and capacity for health center sites, as well as evaluate program implementation. Respondents are Health Centers and Health Center Look-Alikes who are essential in meeting White House goals of equitable vaccine distribution, given the special populations that they serve. HRSA funds 1,400 health centers operating 13,000 services delivery sites serving nearly 30 million people under the Health Center Program. These respondents will play a critical role in ensuring the White House goal to deliver 100 million vaccinations in the first 100 days of the new administration, with a focus on equity.
These data collection tools were developed by HRSA to support implementation of the Health Center COVID-19 Vaccine Program and improve HRSA’s ability to provide resources and technical assistance to health centers and strengthen the federal response to the COVID-19 pandemic. These data collection tools are essential for HRSA’s ability to assess: (1) the readiness and interest of HRSA-funded health centers preliminarily identified by the Centers for Disease Control and Prevention (CDC) and HRSA to receive a direct allocation of a limited supply of COVID-19 vaccines, and (2) progress in vaccine administration and equitable access to vaccine.

US Code: 42 USC 254b, Section 330 Name of Law: PHSA as amended

Not associated with rulemaking


  Total Request 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 134,708 0 0 134,708 0 0
Annual Time Burden (Hours) 100,690 0 0 100,690 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Miscellaneous Actions
This is a new ICR, so burden increases from zero (0).

Elyana Bowman 301 443-3983 [email protected]


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:
    (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;
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.

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