Rural Health Network Development Planning Program Performance Improvement and Measurement System (PIMS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1_redline FORHP 0915-0384 Network Planning Program Measures (proposed revisions June 4 2025)	Form and Instruction	Modified	Available
Form 1 Network Planning PIMS Document	Form and Instruction	Modified	Available
FORHP 0915-0292 OMB NonSubstantive Change Request (BLCP) 6.5.25.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-06-05	Available
FINAL - Revised Supporting Statement A Document Network Planning 03082023.docx	Supporting Statement A	Uploaded 2023-03-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
211181	Rural Health Network Development Planning Program Performance Improvement and Measurement System (PIMS) Form	Form and Instruction	Modified	FORHP 0915-0384 Network Planning Program Measures (proposed revisions June 4 2025)
211181	Rural Health Network Development Planning Program Performance Improvement and Measurement System (PIMS) Form	Form and Instruction	Modified	Network Planning PIMS Document

ICR Details

OMB Control No: 0915-0384	ICR Reference No: 202506-0915-002
Status: Historical Active	Previous ICR Reference No: 202303-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Rural Health Network Development Planning Program Performance Improvement and 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: 06/16/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/16/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2026	04/30/2026	04/30/2026
Responses	23	0	23
Time Burden (Hours)	23	0	23
Cost Burden (Dollars)	0	0	0

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Abstract: Performance measures for the Rural Health Network Development Planning Program (Network Planning 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. The approved measures encompass the following principal topic areas: network infrastructure, network collaboration, sustainability, and network assessment. The respondents for these measures are Rural Health Network Development Planning Program award recipients.

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Authorizing Statute(s): US Code: 42 USC 254(c)(g) 330A(g) Name of Law: Public Health Servie Act, Title III
   PL: Pub.L. 107 - 251 201 Name of Law: Health Care Safety Net Amendments of 2002
   PL: Pub.L. 110 - 355 4 Name of Law: Health Care Safety Net Act of 2008
  

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 75638	12/09/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 14172	03/07/2023
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
Rural Health Network Development Planning Program Performance Improvement and Measurement System (PIMS) Form	1, 1_redline	Network Planning PIMS Document ,   FORHP 0915-0384 Network Planning Program Measures (proposed revisions June 4 2025)

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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	23	23	0	0	0	0
Annual Time Burden (Hours)	23	23	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: $5,274

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: 06/16/2025

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