COVID-19 Provider Relief Fund (PRF) Reporting Activities

Forms and Documents

Document Name	Status
Form 1 COVID-19 Provider Relief Fund (PRF) Reporting Activities Form	New
PRF Reporting Activities - 5 Provider Post-Payment-Notice-of-Reporting-Requirements-June-2021 (1).pdf Supplementary Document	2021-12-07
PRF Reporting Activities - 2 Burden Hour Justification Formula.docx Supplementary Document	2021-12-07
PRF Reporting Activities - Supporting Statement FINAL.docx Supporting Statement A	2021-12-07

IC Document Collections

IC ID	Document Title	Status
250697	COVID-19 Provider Relief Fund (PRF) Reporting Activities Form	New

ICR Details

OMB Control No:	ICR Reference No: 202112-0906-001
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: COVID-19 Provider Relief Fund (PRF) Reporting Activities
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/07/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	308,029	0
Time Burden (Hours)	1,556,212	0
Cost Burden (Dollars)	0	0

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Abstract: Recipients of a PRF payment agreed to a set of Terms & Conditions (T&Cs), which mandate compliance with certain reporting requirements that will facilitate appropriate oversight of recipients’ use of funds. Information collected will allow for (1) assessing whether recipients have met statutory and programmatic requirements, (2) conducting audits, (3) gathering data required to report on findings with respect to the disbursements of PRF payments, and (4) program evaluation. Likely Respondents: PRF recipients who have received more than $10,000 in aggregate PRF payments during one of the Payment Received Periods outlined below and that agreed to the associated T&Cs

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Authorizing Statute(s): None

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:
	86 FR 40064	07/26/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 58079	10/20/2021
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
COVID-19 Provider Relief Fund (PRF) Reporting Activities	1	Data Form Elements

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ICR Summary of Burden

	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	308,029	0	0	308,029	0	0
Annual Time Burden (Hours)	1,556,212	0	0	1,556,212	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, so burden increases from zero (0).

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Annual Cost to Federal Government: $13,385,981

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? Yes

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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: 12/07/2021

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