Rural Health Care Services Outreach Performance Improvement and Measurement Systems (PIMS) Measures

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Rural Health Care Services Outreach Program.docx	Form	Modified	Available
Supporting Statement A - Outreach Program 07062026.docx	Supporting Statement A	Uploaded 2026-07-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
215503	Rural Health Care Services Outreach Program Measures	Form	Modified	Rural Health Care Services Outreach Program.docx

ICR Details

OMB Control No: 0906-0009	ICR Reference No: 202607-0906-002
Status: Received in OIRA	Previous ICR Reference No: 202505-0906-004
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Rural Health Care Services Outreach Performance Improvement and Measurement Systems (PIMS) Measures
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/09/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2028
Responses	58	61
Time Burden (Hours)	508	488
Cost Burden (Dollars)	0	0

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Abstract: The data collection for FORHP’s Outreach Program is conducted with the purpose to capture the impact and scope of HRSA’s FORHP funding on rural communities. The data collected helps identify additional areas for technical assistance. These measures cover the principal topic areas of interest to FORHP including: (1) capacity/organization information, (2) access/population demographics, (3) sustainability, (4) project specific domains, and (5) clinical measures. All measures will speak to FORHP’s progress toward meeting the goals set. FORHP collects this information to quantify the impact of grant funding on access to health care, quality of services, and improvement of health outcomes. FORHP uses the data for program improvement and grantees use the data for performance tracking.

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Authorizing Statute(s): US Code: 42 USC 254c(e) Name of Law: Section 330A (e) of the Public Health Service (PHS) Act
   PL: Pub.L. 116 - 136 330A(e), Title III Name of Law: PHSA
  

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 17660	04/07/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 41644	07/07/2026
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
Rural Health Care Services Outreach Program Measures	1	Rural Health Care Services Outreach Program.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	58	61	0	-3	0	0
Annual Time Burden (Hours)	508	488	0	20	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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 488 hours to 507.50 hours (rounded up to 508). This is due to an increase in the average burden per response from 8 hours to 8.75 hours. This was done based off consultation with four current awardees, described in Sections 8B and 12. The burden has increased due to personnel changes and resulting in training needs of new hires common among rural healthcare workforce in the Outreach Program.

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Annual Cost to Federal Government: $83,050

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: 07/09/2026

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