View Information Collection Request (ICR) Package
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View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0915-0322
ICR Reference No:
200810-0915-001
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
HHS/HSA
Agency Tracking No:
Title:
State Offices of Rural Health TA Data Collection Form
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
12/09/2008
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/03/2008
Terms of Clearance:
This ICR is approved for 18 months and consistent with HRSA memo of 11/20/08. The first year of implementation will be considered a "pilot" year and therefore, the results from the first year of implementation will not be used for GPRA purposes until HRSA has had a chance to evaluate the first year implementation and provide additional guidance or FAQs to SORHs, if necessary.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2010
36 Months From Approved
Responses
50
0
0
Time Burden (Hours)
625
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
The Health Resources and Services Administration (HRSA), Office of Rural Health Policy (ORHP), is requesting OMB approval for a new Technical Assistance Data Form for the State Offices of Rural Health Grant (SORH) program. State Office of Rural Health grantees have provided narrative information on their accomplishments; however, this general information is not standardized and does not provide quantitative detail on the provision of technical assistance. This collection will serve that purpose.
Authorizing Statute(s):
US Code:
42 USC 912
Name of Law: Social Security Act
US Code:
42 USC 254r
Name of Law: Public Health Service Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
73 FR 13005
03/11/2008
30-day Notice:
Federal Register Citation:
Citation Date:
73 FR 56595
09/29/2008
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
State Offices of Rural Health TA Data Collection Form
SORH1
SORH TA Data Collection Form
ICR Summary of Burden
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
50
0
0
50
0
0
Annual Time Burden (Hours)
625
0
0
625
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
This is a new form to collect information regarding technical assistance measurement.
Annual Cost to Federal Government:
$1,600
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Uncollected
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Susan Queen 3014431129
Common Form ICR:
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:
(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:
10/03/2008
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