The HRSA Community Based Outreach Reporting Module

ICR 202109-0906-002

OMB: 0906-0064

Federal Form Document

ICR Details
0906-0064 202109-0906-002
Received in OIRA 202107-0906-001
The HRSA Community Based Outreach Reporting Module
Revision of a currently approved collection   No
Regular 09/30/2021
  Requested Previously Approved
36 Months From Approved 01/31/2022
12,003,000 8,003,000
1,400,801 934,134
0 0

HRSA requests approval to collect program data on its Community-Based Workforce for COVID-19 Vaccine Outreach Programs (CBO Programs), which support nonprofit private or public organizations to establish, expand, and sustain a public health workforce to prevent, prepare for, and respond to COVID-19. This data is needed to comply with requirements to monitor funds distributed under the American Rescue Plan and OMB Memo 21-20.

PL: Pub.L. 117 - 2 0 Name of Law: American Rescue Plan Act of 2021

Not associated with rulemaking

  86 FR 45739 08/16/2021
86 FR 54221 09/30/2021

  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 12,003,000 8,003,000 0 4,000,000 0 0
Annual Time Burden (Hours) 1,400,801 934,134 0 466,667 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Miscellaneous Actions
Burden increase due to an addition of a 4th form for Booster Vaccines.

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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