75 FR 59 pgs. 15436-15437 - Agency Information Collection Activities: Proposed Collection: Comment Request
Type: NOTICEVolume: 75Number: 59Pages: 15436 - 15437
FR document: [FR Doc. 2010-6880 Filed 3-26-10; 8:45 am]
Agency: Health and Human Services Department
Sub Agency: Health Resources and Services Administration
Official PDF Version: PDF Version
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Agency Information Collection Activities: Proposed Collection: Comment Request
In compliance with the requirement for opportunity for public comment on proposed data collection projects (section 3506(c)(2)(A) of Title 44, United States Code, as amended by the Paperwork Reduction Act of 1995, Pub. L. 104-13), the Health Resources and Services Administration (HRSA) publishes periodic summaries of proposed projects being developed for submission to the Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995. To request more information on the proposed project or to obtain a copy of the data collection plans and draft instruments, e-mail paperwork@hrsa.gov or call the HRSA Reports Clearance Officer at (301) 443-1129.
Comments are invited on: (a) The proposed collection of information for the proper performance of the functions of the agency; (b) the accuracy of the agency's estimate of the burden of the proposed collection of information; (c) ways to enhance the quality, utility, and clarity of the information to be collected; and (d) ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or other forms of information technology.
Proposed Project: Federally Qualified Health Centers (FQHC) Application Forms: (OMB No. 0915-0285 Revisions)
HRSA's Bureau of Primary Health Care Federally Qualified Health Centers (FQHCs) are a major component of America's health care safety net, the Nation's "system" of providing health care to low-income and other vulnerable populations. Health Centers care for people regardless of their ability to pay and whether or not they have health insurance. They provide primary and preventive health care, as well as services such as transportation and translation. Many Health Centers also offer dental, mental health and substance abuse care.
FQHC's are administered by the Health Resources and Services Administration's (HRSA) Bureau of Primary Health Care (BPHC). HRSA uses the following application forms to administer and manage the FQHCs. These application forms are used by new and existing FQHCs to apply for grant and non-grant opportunities, renew their grant or non-grant opportunities or change their scope of project.
Estimates of annualized reporting burden are as follows:
| Type of application form | Number of respondents | Responses per respondent | Total responses | Hours per response | Total burden hours |
|---|---|---|---|---|---|
| General Information Worksheet | 1,034 | 1 | 1,034 | 2.0 | 2,068 |
| Planning Grant: General Information Worksheet | 250 | 1 | 250 | 2.5 | 625 |
| BPHC Funding Request Summary | 1,034 | 1 | 1,034 | 2.0 | 2,068 |
| Documents on File | 1,034 | 1 | 1,034 | 1.0 | 1,034 |
| Proposed Staff Profile | 1,034 | 1 | 1,034 | 2.0 | 2,068 |
| Income Analysis Form | 1,034 | 1 | 1,034 | 5.0 | 5,170 |
| Community Characteristics | 1,034 | 1 | 1,034 | 1.0 | 1,034 |
| Health Care Plan (Competing) | 800 | 1 | 1,034 | 4.0 | 4,136 |
| Health Care Plan (Non-Competing) | 1,034 | 1 | 1,034 | 2.0 | 2,068 |
| Business Plan (Competing) | 800 | 1 | 1,034 | 4.0 | 4,136 |
| Business Plan (Non-Competing) | 1,034 | 1 | 1,034 | 2.0 | 2,068 |
| Services Provided | 1,034 | 1 | 1,034 | 1.0 | 1,034 |
| Sites Listing | 1,034 | 1 | 1,034 | 1.0 | 1,034 |
| Other Site Activities | 700 | 1 | 700 | 0.5 | 350 |
| Change In Scope (CIS) Site Add Checklist | 300 | 1 | 300 | 1.0 | 300 |
| CIS Site Delete Checklist | 200 | 1 | 200 | 1.0 | 200 |
| CIS Relocation Checklist | 200 | 1 | 200 | 1.5 | 300 |
| CIS Service Add Checklist | 100 | 1 | 200 | 1.0 | 200 |
| CIS Service Delete Checklist | 100 | 1 | 100 | 1.0 | 100 |
| Board Member Characteristics | 1,034 | 1 | 1,034 | 1.0 | 1,034 |
| Request for Waiver of Governance Requirements | 150 | 1 | 150 | 1.0 | 150 |
| Health Center Affiliation Certification | 250 | 1 | 250 | 1.0 | 250 |
| Need for Assistance | 900 | 1 | 900 | 3.0 | 2,700 |
| Emergency Preparedness Form | 1,034 | 1 | 1,034 | 1.0 | 1,034 |
| Points of Contact | 800 | 1 | 800 | 0.5 | 400 |
| EHR Readiness Checklist | 250 | 1 | 250 | 1.0 | 250 |
| Environmental Information and Documentation (EID) | 400 | 1 | 400 | 2.0 | 800 |
| Assurances | 900 | 1 | 900 | .5 | 450 |
| Equipment List | 900 | 1 | 900 | 1.0 | 900 |
| Other Requirements for Sites | 900 | 1 | 900 | .5 | 450 |
| Total | 1,034 | 1 | 21,876 | 38,411 |
E-mail comments to paperwork@hrsa.gov or mail the HRSA Reports Clearance Officer, Room 10-33, Parklawn Building, 5600 Fishers Lane, Rockville, MD 20857. Written comments should be received within 60 days of this notice.
Dated: March 22,2010.
Sahira Rafiullah,
Director, Division of Policy and Information Coordination.
[FR Doc. 2010-6880 Filed 3-26-10; 8:45 am]
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