View Information Collection Request (ICR) Package

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: 0915-0285	ICR Reference No: 201410-0915-001
Status: Historical Active	Previous ICR Reference No: 201312-0915-005
Agency/Subagency: HHS/HSA	Agency Tracking No: 21063
Title: The Health Center Program Application Forms
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/10/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/09/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2016	09/30/2016	09/30/2016
Responses	32,450	0	32,640
Time Burden (Hours)	44,825	0	45,015
Cost Burden (Dollars)	0	0	0

Authorizing Statute(s): PL: Pub.L. 107 - 251 101 Name of Law: Health Centers
   US Code: 42 USC 254b Name of Law: Health Centers
   PL: Pub.L. 111 - 148 5601 Name of Law: Patient Protection and Affordable Care Act of 2010
   PL: Pub.L. 111 - 148 10503 Name of Law: Patient Protection and Affordable Care Act of 2010
   PL: Pub.L. 111 - 152 2303 Name of Law: Health Care and Educational Reconciliation Act of 2010

Citations for New Statutory Requirements: US Code: 42 USC 300, Section 1006[c] Name of Law: Public Health Service Act

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute
Annual Number of Responses	32,450	32,640	-190
Annual Time Burden (Hours)	44,825	45,015	-190
Annual Cost Burden (Dollars)	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: HRSA is requesting to remove the ninety-five (95) Title X grantees that were added to this information collection now that The Office of Population Affairs (OPA), Office of the Secretary, Department of Health and Human Services has their own OMB approval/number. The ninety-five (95) Title X grantees were added as respondents in a previous non-substantive change. Due to the urgent nature of OPA's data collection We are requesting OMB's approval to this non-substantive change request to remove Title X grantees (total 95 respondents) to our existing HRSA forms to collect data on outreach and enrollment.