American Rescue Plan Act Emergency Rural Health Care (ERHC) Grant Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0575-0200- SUPSTSTMT ARPA-ERHC Grant Program-V. 10 (1-13-2022) update.docx	Supporting Statement A	Uploaded 2022-01-13	Repair queued
OMB-83-I 0575-0200 ARP ERHC-1-12-2022.pdf	Supplementary Document	Uploaded 2022-01-12	Missing upstream
Spreadsheet-ARPA ERHC (1-12-2022).xlsx	Supplementary Document	Uploaded 2022-01-12	Missing upstream
Published NOFA RHS-21-CF-0009.pdf	Supplementary Document	Uploaded 2022-01-06	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
247396	American Rescue Plan Act Emergency Rural Health Care Grant Program	Other-Application Submission Non-Form	Unchanged

ICR Details

OMB Control No: 0575-0200	ICR Reference No: 202202-0575-002
Status: Received in OIRA	Previous ICR Reference No: 202107-0575-002
Agency/Subagency: USDA/RHS	Agency Tracking No: 0575-0200
Title: American Rescue Plan Act Emergency Rural Health Care (ERHC) Grant Program
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 02/08/2022

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	02/28/2022
Responses	15,389	15,389
Time Burden (Hours)	71,681	71,681
Cost Burden (Dollars)	0	0

---

Abstract: The American Rescue Plan Act Emergency Rural Health Care Grant Program was authorized by the American Rescue Plan Act of 2021 to assist rural hospitals and local communities broaden access to COVID-19 vaccines, health care services, and food assistance through food banks and food distribution facilities, and projects supporting the long-term sustainability of rural health care. As authorized under Section 1002 of the American Rescue Plan Act, funds will be made available to eligible applicants to offer support for rural health care services in the form of immediate relief, longer-term funding to advance ideas and solutions to support long-term sustainability of rural health and provide expeditious relief to address the current economic conditions arising from the COVID-19 emergency.

---

Authorizing Statute(s): US Code: 5 USC 808(2) Name of Law: Congressional Review Act
   PL: Pub.L. 117 - 2 1002 Name of Law: American Rescue Plan Act 2021
  

Citations for New Statutory Requirements: PL: Pub.L. 117 - 2 1002 Name of Law: American Rescue Plan Act of 2021

---

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:
	86 FR 44332	08/12/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 5779	02/02/2022
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
American Rescue Plan Act Emergency Rural Health Care Grant Program	AD Form 1047, RD 3570-3, RD 442-2, RD 442-3, RD 442-7	Certification Regarding Debarment, Suspension, and Other Responsibility Matters ,   Community Facilities Grant Agreement ,   Statement of Budget, Income and Equity ,   Balance Sheet ,   Operating Budget

---

ICR Summary of Burden

table that charts list 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	15,389	15,389	0	0	0	0
Annual Time Burden (Hours)	71,681	71,681	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $7,262,677

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.     Yes

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.     Yes

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: 02/08/2022

---