COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Payment Reporting Activities

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Data Form Elements	Form	Modified	Available
Form 1 COVID-19 Provider Relief Fund (PRF) Reporting Activities	Form	Modified	Repair queued
PRF Reporting Activities - Supporting Statement FINAL.docx	Supporting Statement A	Uploaded 2022-10-31	Repair queued
PRF Reporting Activities - 5 Provider Post-Payment-Notice of Reporting Requirements - October 2022.pdf	Supplementary Document	Uploaded 2022-10-27	Repair queued
PRF Reporting Activities - 2 Burden Hour Justification Formula.docx	Supplementary Document	Uploaded 2022-10-27	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
250697	COVID-19 Provider Relief Fund (PRF) Reporting Activities	Form	Modified	Data Form Elements
250697	COVID-19 Provider Relief Fund (PRF) Reporting Activities	Form	Modified

ICR Details

OMB Control No: 0906-0068	ICR Reference No: 202210-0906-003
Status: Historical Active	Previous ICR Reference No: 202112-0906-001
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Payment Reporting Activities
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/26/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/04/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2026	36 Months From Approved	01/31/2023
Responses	308,029	0	308,029
Time Burden (Hours)	1,556,212	0	1,556,212
Cost Burden (Dollars)	0	0	0

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Abstract: The information collected on the PRF Reporting Portal forms will be used by HRSA to (1) assess whether recipients have met statutory and programmatic requirements, (2) conduct audits, (3) gather data required to report on findings with respect to the disbursements of PRF payments, and (4) support program evaluation. HRSA staff will also use information collected to identify and report on trends in health care metrics and expenditures before and during the allowable period for expending PRF payments. If the information is not collected, HRSA will not be able to administer the programs and future distribution cycles would forcibly pause and delay or prevent the distribution of remaining appropriations to providers who are providing critical services during the pandemic. In addition, HRSA’s ability to conduct review and audits on appropriate entities will be jeopardized if data that informs the program review and audit strategies cannot be collected. Finally, effective program evaluation will be severely limited and the program itself will be unable to operate in a fiscally prudent manner.

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Authorizing Statute(s): PL: Pub.L. 116 - 139 0 Name of Law: Paycheck Protection Program (PPP) and Health Care Enhancement Act
   PL: Pub.L. 116 - 260 M Name of Law: Coronavirus Response and Relief Supplemental Appropriations (CRRSA) Act
   PL: Pub.L. 116 - 136 0 Name of Law: The Coronavirus Aid, Relief, and Economic Security (CARES) Act
  

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:
	87 FR 20441	04/07/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 57703	09/21/2022
Did the Agency receive public comments on this ICR? Yes

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

table that charts list of burden

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

table that charts list of burden

	Total Approved	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	308,029	0	0	0	0
Annual Time Burden (Hours)	1,556,212	1,556,212	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:

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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: 11/04/2022

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