Data Use Agreement and Supplement for 2014 Health Center Patient Survey

ICR 201610-0906-001

OMB: 0906-0027

Federal Form Document

Forms and Documents
ICR Details
0906-0027 201610-0906-001
Historical Active
HHS/HRSA
Data Use Agreement and Supplement for 2014 Health Center Patient Survey
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 03/17/2017
Retrieve Notice of Action (NOA) 10/24/2016
  Inventory as of this Action Requested Previously Approved
03/31/2020 36 Months From Approved
40 0 0
30 0 0
0 0 0

The 2014 Health Center Patient Survey (HCPS) surveyed patients who use health centers funded under Section 330 of the Public Health Service Act. Before allowing access to unrestricted HCPS data that contains sensitive grantee and patient information protected by the Privacy Act of 1974, prospective users of the data will submit a signed data use agreement (DUA) and describe (in the associated supplement to the DUA) the proposed research they intend to undertake in using the data. Likely respondents include researchers in academia, private contractors, and Primary Care Associations/Health Center grantee organizations.

US Code: 42 USC 254b, as amended, Sec 330 Name of Law: Public Health Service Act, as amended
  
None

Not associated with rulemaking

  81 FR 27452 05/06/2016
81 FR 69834 10/07/2016
No

1
IC Title Form No. Form Name
Data Use Agreement and Supplement for 2014 Health Center Patient Survey 1, 1 DUA ,   DUA Supplement

  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 40 0 0 40 0 0
Annual Time Burden (Hours) 30 0 0 30 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR, so there is an increase from zero (0).

$2,245
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.
10/24/2016


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