Small Health Care Provider Quality Improvement Program Performance Improvement Measurement System (PIMS)

Forms and Documents

Document	Type	Status	Availability
Form 1 PIMS Measures - SHCPQI	Form and Instruction	Modified	Repair queued
Form 1 Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System	Form and Instruction	Modified	Repair queued
FORHP 0906-0102 OMB NonSubstantive Change Request_062725.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-06-27	Available
FORHP 0906-0102 OMB NonSubstantive Change Request_062725.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-06-27	Repair queued
Supporting Statement A - FORHP - SHCPQI - Revision - 06072024.docx	Supporting Statement A	Uploaded 2024-06-21	Repair queued
Supporting Statement A - FORHP - SHCPQI - Revision - 06072024.docx	Supporting Statement A	Uploaded 2024-06-21	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
211726	Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System	Form and Instruction	Modified	PIMS Measures - SHCPQI
211726	Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System	Form and Instruction	Modified
211726	Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System	Other-Redline	Modified

ICR Details

OMB Control No: 0906-0102	ICR Reference No: 202506-0906-003
Status: Active	Previous ICR Reference No: 202408-0906-004
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Small Health Care Provider Quality Improvement Program Performance Improvement Measurement System (PIMS)
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: 07/03/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/01/2025
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2027	08/31/2027	08/31/2027
Responses	21	0	21
Time Burden (Hours)	284	0	284
Cost Burden (Dollars)	0	0	0

---

Abstract: The purpose of the Small Health Care Provider Quality Improvement Grant (Rural Quality) Program is to provide support to rural primary care providers for implementation of quality improvement activities. Performance measures for the Small Health Care Provider Quality Improvement (SHCPQI) Program serve the purpose of quantifying awardee-level data that conveys the successes and challenges associated with the grant award. These measures and aggregate data substantiate and inform the focus and objectives of the grant program. This data collection provides HRSA with information on how well each grantee is meeting the needs of implementing quality improvement activities in a rural setting. The respondents for these measures are SHCPQI Program award recipients.

---

Authorizing Statute(s): PL: Pub.L. 103 - 62 1116 Name of Law: GPRA
   US Code: 42 USC 254c(g)); Section 330A(g) 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:
	89 FR 7724	02/05/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 52066	06/21/2024
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Small Health Care Provider Quality Improvement Program Performance Improvement and Measurement System	1	PIMS Measures - SHCPQI

---

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	21	21	0	0	0	0
Annual Time Burden (Hours)	284	284	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: There is an increase in the number of burden hours from 168 hours to 283.5 hours (rounded up to 284 in ROCIS). This is due to an increase in the average burden per response from 8 hours to 13.5 hours. This was done based off consultation with three current awardees. The estimates provided were based on the amount of time it takes to review data collection instructions, search existing data sources, gather and maintain the data needed, and complete and review the collection of information. These grantees were sent a draft of the questions that pertain to their program and were asked to estimate how much time it would take to answer the questions.

---

Annual Cost to Federal Government: $2,088

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

---

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: 07/01/2025

---