Rural Health Community-Based Grant Program

Forms and Documents

Document Name	Status
Form 6 Rural Health Workforce Development Program Form and Instruction	New
Form 5 Network Development Planning Grant Program Form and Instruction	Modified
Form 4 Small Health Care Provider Quality Improvement Grant Program Form and Instruction	Modified
Form 3 Delta States Rural Development Network Grant Program Form and Instruction	Modified
Form 2 Rural Health Network Development Form and Instruction	Modified
Form 1 Rural Health Outreach Grant Program Form and Instruction	Modified
Outreach authority (2002)_2010Submission.pdf Supplementary Document	2011-03-23
FINAL Supporting Statement 7.7.11.doc Supporting Statement A	2011-07-19

IC Document Collections

IC ID	Document Title	Status
197088	Rural Health Workforce Development Program Form and Instruction	New
184013	Network Development Planning Grant Program Form and Instruction	Modified
184012	Small Health Care Provider Quality Improvement Grant Program Form and Instruction	Modified
184011	Delta States Rural Development Network Grant Program Form and Instruction	Modified
184010	Rural Health Network Development Form and Instruction	Modified
184009	Rural Health Outreach Grant Program Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0319	ICR Reference No: 201103-0915-002
Status: Historical Active	Previous ICR Reference No: 200803-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Rural Health Community-Based Grant Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/10/2011
	Date Received in OIRA: 03/26/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2014	36 Months From Approved	08/31/2011
Responses	281	0	191
Time Burden (Hours)	1,095	0	353
Cost Burden (Dollars)	0	0	0

---

Abstract: HRSA's Office of Rural Health Policy has developed a Performance Improvement and Measurement System (PIMS)for the collection of information on grant activities and performance measures for six rural health community-based grant programs. These grant programs provide support for sustaining and improving access to quality health care services in rural communities.

---

Authorizing Statute(s): US Code: 42 USC 254c Name of Law: Rural Health Outreach Grant Program
   US Code: 42 USC 254c Name of Law: Rural Health Network Development Program
   PL: Pub.L. 107 - 251 201 Name of Law: Health Care Safety Amendments of 2002
  

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:
	75 FR 76473	12/08/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 13420	03/11/2011
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Rural Health Outreach Grant Program	1	Rural Health Care Outreach
Rural Health Network Development	2	Rhnd
Delta States Rural Development Network Grant Program	3	Delta States Rural Development Network
Small Health Care Provider Quality Improvement Grant Program	4	Small Health Care Provider Quality Improvement
Network Development Planning Grant Program	5	Network Development Planning
Rural Health Workforce Development Program	6	rural Health Workforce Development

---

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	281	191	0	20	70	0
Annual Time Burden (Hours)	1,095	353	0	60	682	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 of 742 hours in the total burden estimate. ORHP has now tailored and refined the measures towards the specific programs and has added some additional components within those measurements. With the addition of a new program, the Rural Health Workforce Development Program, the overall burden estimate has resulted in a burden increase. Finally, ORHP has increased the number of grants awarded, which has resulted in an increase in respondents.

---

Annual Cost to Federal Government: $13,240

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]? 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? 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: 03/26/2011

---