[Federal Register Volume 75, Number 59 (Monday, March 29, 2010)]
[Notices]
[Pages 15436-15437]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-6880]
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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 [email protected] 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:
[[Page 15437]]
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Number of Responses per Total Hours per Total burden
Type of application form respondents respondent responses response hours
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General Information Worksheet... 1,034 1 1,034 2.0 2,068
Planning Grant: General 250 1 250 2.5 625
Information Worksheet..........
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 300 1 300 1.0 300
Checklist......................
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 150 1 150 1.0 150
Requirements...................
Health Center Affiliation 250 1 250 1.0 250
Certification..................
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 400 1 400 2.0 800
Documentation (EID)............
Assurances...................... 900 1 900 .5 450
Equipment List.................. 900 1 900 1.0 900
Other Requirements for Sites.... 900 1 900 .5 450
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Total....................... 1,034 1 21,876 .............. 38,411
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E-mail comments to [email protected] 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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