Small Rural Hospital Transitions (SRHT) Project

ICR 201609-0906-001

OMB: 0906-0026

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
New
Supporting Statement A
2016-09-09
IC Document Collections
ICR Details
0906-0026 201609-0906-001
Historical Active
HHS/HRSA
Small Rural Hospital Transitions (SRHT) Project
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 03/03/2017
Retrieve Notice of Action (NOA) 09/09/2016
  Inventory as of this Action Requested Previously Approved
03/31/2020 36 Months From Approved
2,010 0 0
788 0 0
0 0 0

The information is needed to select nine small rural hospitals to receive on-site TA through HRSA’s Small Rural Hospital Transitions (SRHT) project. Information will be solicited via online application form and a hospital assessment. Intended responders are small rural hospitals residing in areas of persistent poverty. Hospitals may be for profit or not-for profit.

None
None

Not associated with rulemaking

  81 FR 41315 06/24/2016
81 FR 62512 09/09/2016
No

1
IC Title Form No. Form Name
Small Rural Hospital Transitions (SRHT) Project 1, 2 SRHT Application Form ,   PE Assessment for Rural Hospitals

  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 2,010 0 0 2,010 0 0
Annual Time Burden (Hours) 788 0 0 788 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR, so the burden increase is from zero (0). Authorizing statue not applicable for this ICR package.

$139,770
No
No
No
No
No
Uncollected
Elyana Bowman 301 443-3983 enadjem@hrsa.gov

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
09/09/2016


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