Health Center Workforce Survey Evaluation and Technical Assistance

Forms and Documents

Document Name	Status
Form 2 Health Center Workforce Well-being Survey Form and Instruction	New
Form 1 Health Center Workforce Survey Form and Instruction	New
20220323_Workforce Survey Eval and TA Supporting Statement B_cleansnedits.docx Supporting Statement B	2022-09-01
FINAL20220825_Workforce Survey Eval and TA Supporting Statement A_burden statement updatedFINAL.docx Supporting Statement A	2022-09-01

IC Document Collections

IC ID	Document Title	Status
255819	Health Center Workforce Well-being Survey Form and Instruction	New
255724	Health Center Workforce Survey Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202208-0906-003
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Health Center Workforce Survey Evaluation and Technical Assistance
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: 09/13/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	451,400	0
Time Burden (Hours)	225,467	0
Cost Burden (Dollars)	0	0

---

Abstract: Workforce well-being, burnout, and satisfaction are critical factors in assuring high-quality patient care delivery within HRSA-supported health centers. Ignoring staff well-being and satisfaction can lead to rapidly escalating difficulties under which staff become detached or frustrated, which decreases quality, safety, and patient connection while ultimately leading to persistent difficulties with workforce recruitment, retention, and productivity. In order to identify causes, impacts, and extent of staff well-being, burnout, and job satisfaction, a workforce survey was developed as one of the deliverables of the Health Center Workforce Well-Being/Satisfaction Survey contract that will be administered across HRSA funded health centers nationally. The activities conducted during the Health Center Workforce Well-Being/Satisfaction Survey development contract were approved under OMB Control No. 0915-XXXX. This survey will provide insight into the factors impacting workforce well-being and satisfaction at the national and health center levels and across all health center occupations. By quantifying and analyzing these factors, efforts to improve conditions can be implemented and evaluated as to their effectiveness, with the long-term goal of improving patient quality of care and promoting HRSA supported health centers as a leaders in workforce recruitment and retention and well-being.

---

Authorizing Statute(s): US Code: 42 USC 254b Name of Law: Public Health Service 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 14019	03/10/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 33173	06/01/2022
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Health Center Workforce Survey	1	English Spanish HRSA Health Center Workforce Survey
Health Center Workforce Well-being Survey	2	HRSA's Health Center's Well-being Survey

---

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	451,400	0	0	451,400	0	0
Annual Time Burden (Hours)	225,467	0	0	225,467	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 package.

---

Annual Cost to Federal Government: $2,080,495

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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? 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: 09/13/2022

---