Shortage Designation Management System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form D SDMS Supplemental Information - Attachment D.docx	Form and Instruction	Unchanged	Available
Form D SDMS Application	Form and Instruction	Unchanged	Repair queued
Form G Manual for Policies and Procedures - Attachment G.pdf	Form and Instruction	Modified	Available
Form F PCO Designation Management User Guide - Attachment F.pdf	Form and Instruction	Modified	Available
Form E PCO Provider Management User Guide - Attachment E.pdf	Form and Instruction	Modified	Available
Form E Designation, Planning, and Preparation	Form and Instruction	Modified	Repair queued
SDMS Supporting Statement - Final.docx	Supporting Statement A	Uploaded 2023-03-23	Repair queued
2022 Designated MH HPSA FRN - Attachment L.pdf	Supplementary Document	Uploaded 2023-03-23	Repair queued
2022 Designated DT HPSA FRN - Attachment K.pdf	Supplementary Document	Uploaded 2023-03-23	Available
2022 Designated PC HPSA FRN - Attachment J.pdf	Supplementary Document	Uploaded 2023-03-23	Repair queued
State PCO NOFO HRSA-2019 - 2024 FINAL - Attachment I.pdf	Supplementary Document	Uploaded 2023-03-23	Repair queued
SDMS 60 Day FRN - Attachment H.pdf	Supplementary Document	Uploaded 2023-03-23	Repair queued
HPSA Regulations - Attachment C.pdf	Supplementary Document	Uploaded 2023-03-23	Repair queued
MUAP Statute - Attachment B.pdf	Supplementary Document	Uploaded 2023-03-23	Repair queued
HPSA Statute - Attachment A.pdf	Supplementary Document	Uploaded 2023-03-23	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
241813	SDMS Application	Form and Instruction	Unchanged	SDMS Supplemental Information - Attachment D.docx
241813	SDMS Application	Form and Instruction	Unchanged
219565	Designation, Planning, and Preparation	Form and Instruction	Modified	Manual for Policies and Procedures - Attachment G.pdf
219565	Designation, Planning, and Preparation	Form and Instruction	Modified	PCO Designation Management User Guide - Attachment F.pdf
219565	Designation, Planning, and Preparation	Form and Instruction	Modified	PCO Provider Management User Guide - Attachment E.pdf
219565	Designation, Planning, and Preparation	Form and Instruction	Modified

ICR Details

OMB Control No: 0906-0029	ICR Reference No: 202303-0906-002
Status: Historical Active	Previous ICR Reference No: 202005-0906-001
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Shortage Designation Management System
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/27/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/23/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2026	36 Months From Approved	07/31/2023
Responses	7,074	0	7,074
Time Burden (Hours)	38,664	0	38,664
Cost Burden (Dollars)	0	0	0

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Abstract: The need and purpose of this information collection is to obtain information from the State Primary Care Offices (PCO) via the Shortage Designation Management System (SDMS) for the review of geographic area, population, or facility Health Professional Shortage Area (HPSA) and Medically Underserved Area/Population (MUAP) designations. The application asks for national, state and local data required to determine the area, population, or facility’s eligibility for a shortage designation. The respondents for this information collection are State PCO who seek to improve primary care service delivery and workforce availability in the State or territory to meet the needs of underserved populations.

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Authorizing Statute(s): US Code: 42 USC 254b Title III Section 330(b) Name of Law: Public Health Service Act as Amended by 42 USC
   US Code: 42 USC 254e Title III Section 332 Name of Law: Public Health Service Act as Amended by 42 USC
  

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:
	88 FR 360	01/04/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 17584	03/23/2023
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Designation, Planning, and Preparation	E, F, G	PCO Provider Management User Guide - Attachment E.pdf ,   PCO Designation Management User Guide - Attachment F.pdf ,   Manual for Policies and Procedures - Attachment G.pdf
SDMS Application	D	SDMS Supplemental Information - Attachment D.docx

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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	7,074	7,074	0	0	0	0
Annual Time Burden (Hours)	38,664	38,664	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: $7,348,446

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? No

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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: 03/23/2023

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