Rural Health Clinic COVID-19 (RHC COVID-19)Testing Program Data Collection

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Rural Health Clinic COVID-19 (RHC COVID-19) Testing Program Data Collection	Form and Instruction	Unchanged	Repair queued
FORM - HRSA FORHP COVID-19 Data Report.docx	Supplementary Document	Uploaded 2022-05-17	Available
Supporting Statement A.docx	Supporting Statement A	Uploaded 2022-05-17	Missing upstream

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
243770	Rural Health Clinic COVID-19 (RHC COVID-19) Testing Program Data Collection	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0906-0056	ICR Reference No: 202205-0906-002
Status: Received in OIRA	Previous ICR Reference No: 202109-0906-001
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Rural Health Clinic COVID-19 (RHC COVID-19)Testing Program Data Collection
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/18/2022

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	43,719	0
Time Burden (Hours)	14,427	0
Cost Burden (Dollars)	0	0

---

Abstract: HRSA Federal Office of Rural Health Policy (FORHP) created a monthly, aggregate data report to collect information on COVID-19 testing, COVID-19 mitigation, and related expenses conducted by Rural Health Clinics (RHCs). RHCs were identified by Tax ID number and an organization may operate one or more RHC sites which were identified by unique CMS Certification Numbers (CCN). Respondents are TIN organizations that own or operate one or more RHCs who received funding for COVID-19 testing, COVID-19 mitigation, and related expenses. HRSA issued funding as one-time payments to 2,301 TIN organizations based on the number of certified clinic sites they operate, providing $100,000 per clinic site (4,459 RHC sites total across the country). Data report information is needed to comply with federal requirements to monitor funds distributed under The American Rescue Plan Act.

---

Authorizing Statute(s): PL: Pub.L. 116 - 139 Division B, Title I Name of Law: Paycheck Protection Program and Health Care Enhancement Act, Public Health and Social Services Emerg
   PL: Pub.L. 117 - 2 Division B, Title I Name of Law: American Rescue Plan Act
  

Citations for New Statutory Requirements: None

---

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:
	87 FR 103	01/03/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 15440	03/18/2022
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
Rural Health Clinic COVID-19 (RHC COVID-19) Testing Program Data Collection	1	HRSA FORHP COVID-19 Data Report 9.2021_CLEAN.docx

---

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	43,719	0	0	0	0	43,719
Annual Time Burden (Hours)	14,427	0	0	0	0	14,427
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: $60,903

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

---

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: 05/18/2022

---