Small Rural Hospital Improvement Program (SHIP) COVID-19 Testing and Mitigation Reporting Portal

Forms and Documents

Document Name	Status
Form 0906-0066 Small Rural Hospital Improvement Program COVID-19 Testing and Mitigation Reporting Portal Form and Instruction	Modified
5. Supporting Statement A - SHIP COVID Testing Mitigation Program_revised.docx Supporting Statement A	2022-05-09
10122021 OMB memo to OIRA Final Signed 100120215011.pdf Supplementary Document	2021-10-13

IC Document Collections

IC ID	Document Title	Status
249666	Small Rural Hospital Improvement Program COVID-19 Testing and Mitigation Reporting Portal Form and Instruction	Modified

ICR Details

OMB Control No: 0906-0066	ICR Reference No: 202205-0906-001
Status: Received in OIRA	Previous ICR Reference No: 202110-0906-004
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Small Rural Hospital Improvement Program (SHIP) COVID-19 Testing and Mitigation Reporting Portal
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/09/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	9,240	0
Time Burden (Hours)	2,310	0
Cost Burden (Dollars)	0	0

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Abstract: HRSA Federal Office of Rural Health Policy created a quarterly, aggregate data report to collect information on COVID-19 testing and mitigation activities conducted by small rural hospitals receiving SHIP funding. Respondents are SHIP grantees or their small rural hospitals who received funding for COVID-19 testing and mitigation related expenses. HRSA issued funding as one-time payments to 46 state offices of rural health based on the number of eligible hospitals, providing $258,376 per hospital (1540 hospitals total across the country). The organizations were identified by CMS Certification Numbers (CCN). Data report information is needed to comply with federal requirements to monitor funds distributed under the American Rescue Plan Act.

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Authorizing Statute(s): US Code: 42 USC 912(b)(5) Name of Law: American Rescue Plan Act
  

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:
	86 FR 74095	12/29/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 15438	03/18/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Small Rural Hospital Improvement Program COVID-19 Testing and Mitigation Reporting Portal	0906-0066	HRSA FORHP COVID-19 Data Report

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ICR Summary 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	9,240	0	0	0	0	9,240
Annual Time Burden (Hours)	2,310	0	0	0	0	2,310
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $58,813

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? Yes

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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: 05/09/2022

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