Rural Health Community-Based Grant Programs Data Collection Tool

Forms and Documents

Document Name	Status
Form 1 Rural Health Information Technology Network Development Form and Instruction	Modified
RHITND_Environment.pdf Supplementary Document	2012-07-24
RHITND_Demographics.pdf Supplementary Document	2012-07-24
Outreach authority (2005).pdf Supplementary Document	2012-05-23
Supporting_Statement.docx Supporting Statement A	2013-05-28

IC Document Collections

IC ID	Document Title	Status
202626	Rural Health Information Technology Network Development Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0354	ICR Reference No: 201305-0915-005
Status: Historical Active	Previous ICR Reference No: 201206-0915-003
Agency/Subagency: HHS/HSA	Agency Tracking No: 19537
Title: Rural Health Community-Based Grant Programs Data Collection Tool
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/18/2013
	Date Received in OIRA: 05/28/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2016	36 Months From Approved	08/31/2015
Responses	41	0	41
Time Burden (Hours)	233	0	155
Cost Burden (Dollars)	0	0	0

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Abstract: HRSA's Office of Rural Health Policy is requesting OMB approval of a new activity to collection information on grantee activities and performance measures electronically through the Performance Improvement and Measurement System (PIMS). This activity will collect information for the Rural Health Information Technology Network Development Program (RHITND) to provide HRSA with information on grant activities funded under this program, as well as information to meet requirements under the Government Performance and Results Act of 1993 (GPRA).

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Authorizing Statute(s): PL: Pub.L. 107 - 251 330A Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 14804	03/07/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 31562	05/24/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Rural Health Information Technology Network Development	1	RHITND PIMS

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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	41	41	0	0	0	0
Annual Time Burden (Hours)	233	155	0	78	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: The purpose of the Rural Health Information Technology Network Development (RHITND) program is to improve health care and support the adoption of HIT in rural America by providing targeted HIT support to rural health networks. Through this program, adoption of Meaningful Use standards will be assessed. Since there were changes in HIT Meaningful Use criteria, additional questions were added on this form to reflect those changes which increased the burden hours by 78 hours. However, there are no changes to the RHITND Program.

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Annual Cost to Federal Government: $36,072

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 05/28/2013

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