Evaluation and Initial Assessment of HRSA Teaching Health Centers

Forms and Documents

Document Name	Status
Form 1 THC Graduation Survey Form and Instruction	New
Form 1 THC Matriculant Survey Form and Instruction	New
Form 1 THC Alumni Survey Form and Instruction	New
Form 1 Program Data Collection Tool Form and Instruction	New
OMB Mapping 12-18-13.xlsx Supplementary Document	2014-02-26
OMB Supporting Statement B THC Eval 25 Feb 2014.docx Supporting Statement B	2014-02-26
Supporting Statement A THC Eval 25 Feb 2014.docx Supporting Statement A	2014-02-26

IC Document Collections

IC ID	Document Title	Status
208627	THC Graduation Survey Form and Instruction	New
208626	THC Matriculant Survey Form and Instruction	New
208625	THC Alumni Survey Form and Instruction	New
208624	Program Data Collection Tool Form and Instruction	New

ICR Details

OMB Control No: 0915-0376	ICR Reference No: 201309-0915-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No: 20464
Title: Evaluation and Initial Assessment of HRSA Teaching Health Centers
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: 03/06/2014
	Date Received in OIRA: 09/12/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	36 Months From Approved
Responses	645	0	0
Time Burden (Hours)	526	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Affordable Care Act of 2010 specifically requires that Teaching Health Center Graduate Medical Education Programs report annually on the types of primary care residents trained, the number trained, the number who complete residency, the number who care for vulnerable populations and any other information as deemed appropriate by the Secretary. In order to comply with the law and ensure goals and reporting requirements of the THCGME program are met, four data collection instruments have been developed to collect information from each THC program and their residents: 1) Program Data Collection Tool, 2) THC Matriculant Survey, 3) THC Graduate Survey, and 4) THC Alumni Survey. Section 5508 of the Affordable Care Act of 2010 (ACA) established the Teaching Health Center Graduate Medical Education (THCGME) program to support the expansion of new and existing primary care residency training programs in community-based settings. The primary goals of this program are to increase the production of primary care doctors who are well prepared to practice in community settings, particularly with underserved populations, and to improve the overall number and geographic distribution of primary care providers.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 5508 Name of Law: Patient Protection and Affordable Care Act of 2010
  

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 35285	06/12/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 55730	09/11/2013
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Program Data Collection Tool	1	Program Data Collection Tool
THC Alumni Survey	1	Alumni Survey
THC Matriculant Survey	1	Matriculant Survey
THC Graduation Survey	1	Graduation Survey

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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	645	0	0	645	0	0
Annual Time Burden (Hours)	526	0	0	526	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 information collection.

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Annual Cost to Federal Government: $180,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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]? Yes

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: 09/12/2013

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