State Office of Rural Health Grant Technical Assistance

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Instrument - 0915-0322 - FORHP - SORH Collection Tool - Revision - 04172026.docx	Form and Instruction	Modified	Available
SORH 30 Day FRN Supporting Statement A (OMB).docx	Supporting Statement A	Uploaded 2026-04-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
186810	State Offices of Rural Health TA Data Collection Form	Form and Instruction	Modified	Instrument - 0915-0322 - FORHP - SORH Collection Tool - Revision - 04172026.docx

ICR Details

OMB Control No: 0915-0322	ICR Reference No: 202604-0915-003
Status: Received in OIRA	Previous ICR Reference No: 202303-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No: 19868
Title: State Office of Rural Health Grant Technical Assistance
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 04/24/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	04/30/2026
Responses	50	50
Time Burden (Hours)	675	675
Cost Burden (Dollars)	0	0

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Abstract: FORHP seeks to continue gathering information from grantees on their efforts to provide technical assistance to clients within their State. SORH grantees submit a Technical Assistance Report that includes: (1) the total number of technical assistance encounters provided directly by the grantee; and, (2) the total number of unduplicated clients that received direct technical assistance from the grantee. These measures will continue in these three categories: (1) information disseminated, (2) information created, and (3) collaborative efforts by a) topic area and b) type of audience. These measures are used to obtain an accurate depiction of the breadth of SORH work, based on recommendations from the grantees. Submission of the Technical Assistance Report is submitted via the HRSA Electronic Handbook no later than 60 days after the end of each twelve month budget period. Likely Respondents: Fifty (50) State Offices of Rural Health award recipients.

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Authorizing Statute(s): US Code: 42 USC 912 Name of Law: Office of Rural Health Policy
   US Code: 42 USC 254r Name of Law: Public Health Service 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:
	91 FR 3897	01/29/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 22157	04/24/2026
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
State Offices of Rural Health TA Data Collection Form	1	Instrument - 0915-0322 - FORHP - SORH Collection Tool - Revision - 04172026.docx

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	50	50	0	0	0	0
Annual Time Burden (Hours)	675	675	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: $54,377

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: 04/24/2026

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