HRSA Environmental Information and Documentation (EID)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1_R FORM - environmental_checklist - 051625 (redline)_final.docx	Form	Modified	Available
Form 1 FORM - environmental_checklist - 051625 (clean)_final.docx	Form	Modified	Available
Form 1 Environmental Information and Documentation Checklist	Form	Modified	Available
Supporting Statement 2025 - EID FRN 30 day 051625 (redline)_final.docx	Supporting Statement A	Uploaded 2025-05-29	Repair queued
Supporting Statement 2025 - EID FRN 30 day 011425.docx	Supporting Statement A	Uploaded 2025-01-21	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
189032	Environmental Information and Documentation Checklist	Form	Modified	FORM - environmental_checklist - 051625 (redline)_final.docx
189032	Environmental Information and Documentation Checklist	Form	Modified	FORM - environmental_checklist - 051625 (clean)_final.docx
189032	Environmental Information and Documentation Checklist	Form	Modified

ICR Details

OMB Control No: 0915-0324	ICR Reference No: 202501-0915-001
Status: Active	Previous ICR Reference No: 202203-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: HRSA Environmental Information and Documentation (EID)
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 with change	Conclusion Date: 07/03/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/21/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2028	36 Months From Approved	07/31/2025
Responses	1,500	0	1,500
Time Burden (Hours)	1,500	0	1,500
Cost Burden (Dollars)	0	0	0

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Abstract: National Environmental Policy Act’s (NEPA) implementing regulations under 40 CFR parts 1500-1508, and the HHS General Administration Manual Part 30 Environmental Protection procedures, require HRSA to consider the potential impacts of a proposed action on the human environment prior to committing the Agency to the action. The NEPA process incorporates consideration of other related federal environmental and historic preservation laws with which HRSA, and applicants must also comply. The series of questions in the Environmental Information and Documentation (EID) form collects specific project and site related information not collected in other application forms. This information is needed to determine the level of review required under NEPA and related laws. HRSA uses the information collected to determine compliance with NEPA, and the EID becomes part of the administrative record for grantees to meet their assurances requirements for receiving a grant. HRSA will use the EID information along with overall program applications to determine eligibility and the level of environmental review required under NEPA for construction related awards. For example, information submitted on the EID may show that the proposed project impact is minimal and therefore the project requires no further review under NEPA and other related laws. Alternatively, the results of the EID may also identify that the proposed project does require further review and evaluation such as: 1) the preparation and public notice of an Environmental Assessment under NEPA; 2) consultation under Section 106 of the National Historic Preservation Act (NHPA); 3) site testing for the presence of hazardous materials such as asbestos or lead; or 4) further consultation and coordination with other Federal Agencies on issues such as endangered species, floodplain management or wetland permits.

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Authorizing Statute(s): US Code: 42 USC 4321 Name of Law: National Environmental Policy 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:
	89 FR 84898	10/24/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 5915	01/17/2025
Did the Agency receive public comments on this ICR? No

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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
Environmental Information and Documentation Checklist	1, 1_R	FORM - environmental_checklist - 051625 (clean)_final.docx ,   FORM - environmental_checklist - 051625 (redline)_final.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	1,500	1,500	0	0	0	0
Annual Time Burden (Hours)	1,500	1,500	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: $544,782

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)? Yes

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: 01/21/2025

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