COVID–19 Provider Relief Programs Single and Commercial Audits and Delinquent Audit Reporting Submission Activities

Forms and Documents

Document	Type	Status	Availability
Form 3 Questioned Cost Attestation Form	Form and Instruction	Unchanged	Repair queued
Form 3 Provider Relief Fund (PRF) Questioned Cost Attestation Form	Form and Instruction	Unchanged	Repair queued
Form 2 Delinquent Audit Follow-Up Attestation Form.	Form and Instruction	Unchanged	Available
Form 2 Delinquent Audit Follow-up Email and Attestation	Form and Instruction	Unchanged	Repair queued
Form 1 PRF Commercial Audit Reporting Portal	Form and Instruction	Unchanged	Available
Form 1 PRF Commercial Audit Form	Form and Instruction	Unchanged	Repair queued
OFAAM_0906 0083_Below the Audit Threshold Email (New Email).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-05-09	Available
OFAAM_0906 0083_Below the Audit Threshold Email (New Email).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-05-09	Repair queued
OFAAM_0906 0083_OMB NonSubstantive Change Request.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-05-09	Repair queued
OFAAM_0906 0083_OMB NonSubstantive Change Request.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-05-09	Repair queued
OMB NonSubstantive Change Request_DFI CARD PRA_3-15-24.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-03-19	Repair queued
OMB NonSubstantive Change Request_DFI CARD PRA_3-15-24.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-03-19	Repair queued
02012024 Provider Relief Program Emergency Clearance Memo_Final.pdf	Supplementary Document	Uploaded 2024-02-08	Available
02012024 Provider Relief Program Emergency Clearance Memo_Final.pdf	Supplementary Document	Uploaded 2024-02-08	Repair queued
Supporting Statement A - COVID 19 PRF Audits - Revision - 11012024.docx	Supporting Statement A	Uploaded 2024-11-01	Available
Supporting Statement A - COVID 19 PRF Audits - Revision - 11012024.docx	Supporting Statement A	Uploaded 2024-11-01	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
264092	Provider Relief Fund (PRF) Questioned Cost Attestation Form	Form and Instruction	Unchanged	Questioned Cost Attestation Form
264092	Provider Relief Fund (PRF) Questioned Cost Attestation Form	Form and Instruction	Unchanged
264091	Delinquent Audit Follow-up Email and Attestation	Form and Instruction	Unchanged	Delinquent Audit Follow-Up Attestation Form.
264091	Delinquent Audit Follow-up Email and Attestation	Form and Instruction	Unchanged
264091	Delinquent Audit Follow-up Email and Attestation	Instruction	Unchanged
264090	Delinquent Audit Follow-up General Email Blast	Instruction	Unchanged
264089	Commercial Audit Compliance Email	Instruction	Unchanged
264088	PRF Commercial Audit Form	Form and Instruction	Unchanged	PRF Commercial Audit Reporting Portal
264088	PRF Commercial Audit Form	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0906-0083	ICR Reference No: 202505-0906-003
Status: Active	Previous ICR Reference No: 202408-0906-002
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: COVID–19 Provider Relief Programs Single and Commercial Audits and Delinquent Audit Reporting Submission Activities
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/29/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/14/2025
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2027	11/30/2027	11/30/2027
Responses	385,500	0	385,500
Time Burden (Hours)	439,375	0	439,375
Cost Burden (Dollars)	0	0	0

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Abstract: HRSA will use the information for the purpose of ensuring that providers who received over $750,000 in funding from any of the Provider Relief Program combined to 1) submit an audit per 45 CFR 75 Subpart F, 2) any documentation and attestation needed to resolve any audit findings, and 3) an attestation or documentation to prove an audit is not required. If the information is not collected, HRSA will not be in compliance with 45 CFR 75 Subpart F and will limit HRSA’s ability to monitor the Federal programs. In addition, HRSA’s ability to conduct delinquent audit follow-up on appropriate entities will be jeopardized if we cannot verify who has submitted their audit. There would be a harm to the public if this collection is not approved because HRSA would be delayed in following 45 CFR 75 Subpart F and recovering federal funds not utilized in accordance with the Provider Relief Program Terms and Conditions.

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Authorizing Statute(s): PL: Pub.L. 116 - 260 0 Name of Law: Coronavirus Response and Relief Supplemental Appropriations
   PL: Pub.L. 116 - 136 0 Name of Law: Coronavirus Aid, Relief, and Economic Security (CARES) Act
   PL: Pub.L. 116 - 127 0 Name of Law: Families First Coronavirus Response Act
   PL: Pub.L. 117 - 2 0 Name of Law: American Rescue Plan Act of 2021
   PL: Pub.L. 116 - 139 0 Name of Law: Paycheck Protection Program (PPP) and Health Care Enhancement 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 35842	05/02/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 65637	08/12/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Commercial Audit Compliance Email
Delinquent Audit Follow-up Email and Attestation	2	Delinquent Audit Follow-Up Attestation Form.
Delinquent Audit Follow-up General Email Blast
PRF Commercial Audit Form	1	PRF Commercial Audit Reporting Portal
Provider Relief Fund (PRF) Questioned Cost Attestation Form	3	Questioned Cost Attestation Form

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ICR Summary 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	385,500	385,500	0	0	0	0
Annual Time Burden (Hours)	439,375	439,375	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: The Delinquent Audit Follow-up General Email Blast that was included in the Emergency Clearance Package has been adjusted to provide additional clarification to providers about the audit requirements and include the attestation form, the average burden hours per response increased from 0.05 hours to 0.25 hours. As a result, the estimated burden for the Delinquent Audit Follow-up General Email Blast increased from 12,600 to 63,000, an increase of 50,400 respondents. The estimated burden for the entire collection increased from 388,975 to 439,375.

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Annual Cost to Federal Government: $5,598,937

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: 05/14/2025

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