HHS Payment Management System Forms PMS-270 - Request for Advance or Reimbursement and PMS-272 - Federal Cast Transaction Report

Forms and Documents

Document Name	Status
Form 270 270 form Form	New
0937-0200-09-28-2007.doc Supporting Statement A	2007-09-28

IC Document Collections

IC ID	Document Title	Status
7751	272- form Other-form	Modified
182185	270 form Form	New

ICR Details

OMB Control No: 0937-0200	ICR Reference No: 200709-0937-001
Status: Historical Active	Previous ICR Reference No: 200403-0937-001
Agency/Subagency: HHS/OASH	Agency Tracking No:
Title: HHS Payment Management System Forms PMS-270 - Request for Advance or Reimbursement and PMS-272 - Federal Cast Transaction Report
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/05/2007
	Date Received in OIRA: 09/28/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2010	36 Months From Approved	12/31/2007
Responses	91,480	0	73,560
Time Burden (Hours)	267,510	0	220,980
Cost Burden (Dollars)	0	0	0

---

Abstract: The PSC-270 is used to request advance or reimbursement payments to grantees. It serves in place of the SF-270. The PSC-272 is used to monitor cash advances made to grantees and the collect disbursement data. It serves in place of the SF-272.

---

Authorizing Statute(s): US Code: 42 USC 301 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:
	72 FR 35710	06/29/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 53587	09/19/2007
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
270 form	270	Request for advance Reimbursement
272- form

---

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	91,480	73,560	0	17,920	0	0
Annual Time Burden (Hours)	267,510	220,980	0	46,530	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: The 267,510 estimated annual burden hours for the use of these forms is a 46,530 hour increase from the previously approved burden estimates. This increase is a program change due to the increased number of respondents placed on payment restriction in order to allow the awarding agencies to monitor drawdown activity. In addition, number of respondents utilizing the Payment Management System has increased since the previously approved burden estimates.

---

Annual Cost to Federal Government: $3,500

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

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: 09/28/2007

---