75 FR 112 pgs. 33310-33311 - Agency Information Collection Activities: Submission for OMB Review; Comment Request
Type: NOTICEVolume: 75Number: 112Pages: 33310 - 33311
FR document: [FR Doc. 2010-14108 Filed 6-10-10; 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: Submission for OMB Review; Comment Request
Periodically, the Health Resources and Services Administration (HRSA) publishes abstracts of information collection requests under review by the Office of Management and Budget (OMB), in compliance with the Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35). To request a copy of the clearance requests submitted to OMB for review, e-mail paperwork@hrsa.gov or call the HRSA Reports Clearance Office on (301) 443-1129.
The following request has been submitted to the Office of Management and Budget for review under the Paperwork Reduction Act of 1995:
Proposed Project: Federally Qualified Health Centers (FQHC) Application Forms: (OMB No. 0915-0285)-Revisions
HRSA's Bureau of Primary Health Care administers grants to Health Centers receiving funding under section 330 of the Public Health Service Act and has an approval process for organizations seeking to qualify as Federally Qualified Health Center (FQHC) Look Alikes. These Health Centers and FQHC Look Alikes provide preventive and primary health care services to low-income and other vulnerable populations, regardless of their ability to pay and whether or not they have health insurance. Many Health Centers and FQHC Look-Alikes offer dental, mental health and substance abuse care.
HRSA uses the following application forms to administer Section 330 Health Centers grants and the FQHC Look Alike application process. These application forms are used by new and existing Health Centers and FQHC Look-Alikes 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 |
| Capital Improvement/Investment Proposal Cover Page | 700 | 1 | 700 | 1.0 | 700 |
| Assurances | 900 | 1 | 900 | .5 | 450 |
| Capital Improvement/Investment Project Cover | 700 | 1 | 700 | 1.0 | 700 |
| Capital Improvement/Investment Project Impact | 700 | 1 | 700 | .5 | 350 |
| Equipment List | 900 | 1 | 900 | 1.0 | 900 |
| Other Requirements for Sites | 900 | 1 | 900 | .5 | 450 |
| Total | 1,138 | 1 | 23,976 | 40,161 |
Written comments and recommendations concerning the proposed information collection should be sent within 30 days of this notice to the desk officer for HRSA, either by email to OIRA_submission@omb.eop.gov or by fax to 202-395-6974. Please direct all correspondence to the "attention of the desk officer for HRSA."
Dated: June 7, 2010.
Sahira Rafiullah,
Director, Division of Policy and Information Coordination.
[FR Doc. 2010-14108 Filed 6-10-10; 8:45 am]
BILLING CODE 4165-15-P