Agency Information Collection Activities: Submission for OMB Review; Comment Request

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration

Agency Information Collection Activities: Submission for OMB Review; Comment Request

Periodically, the Health Resources and Services Administration (HRSA) publishes abstracts of information collection requests under review by the Office of Management and Budget (OMB), in compliance with the Paperwork Reduction Act of 1995 (44 U.S.C. Chapter 35). To request a copy of the clearance requests submitted to OMB for review, call the HRSA Reports Clearance Office on (301)-443-1129.

The following request has been submitted to the Office of Management and Budget for review under the Paperwork Reduction Act of 1995:

Proposed Project: The Health Center Program Application Forms: (OMB No. 0915-0285 Extension)

Health centers receiving grant funding under Section 330 of the Public Health Service (PHS) Act are a major component of America's health care safety net, the Nation's “system” of providing primary health care to underserved communities and vulnerable populations. Health centers care for people regardless of their ability to pay and whether or not they have health insurance. They provide primary health care, as well as services such as transportation and translation. Many health centers also offer dental, mental heath, and substance abuse care. Grants to health centers are administered by HRSA's Bureau of Primary Health Care (BPHC). In an effort to encourage the creation of new health centers and sites as well as improve and strengthen existing sites, HRSA periodically issues new grant opportunities.

HRSA uses the following application forms to administer and manage the Federal Qualified Health Center. These application forms are used by new and existing FQHC's to apply for grant and non-grant opportunities, re-new their grant or non-grant opportunities or change their scope of project.

Estimates of annualized reporting burden are as follows:

Type of application form

Number of respondents

Responses per

respondent

Total

responses

Hours per

response

Total burden hours

General Information Worksheet

1,021

1

1,021

3.0

3,063

P12 Planning General Information Worksheet

300

1

300

12.0

3,600

BPHC Funding Request Summary

1,021

1

1,021

0.5

510.5

Proposed Staff Profile

1,021

1

1,021

6.0

6,126

Income Analysis Form

1,021

1

1,021

15.0

15,315

Community Characteristics

1,021

1

1,021

12.0

12,252

Services Provided

1,021

1

1,021

0.5

510.5

Sites Listing

1,021

1

1,021

1.0

1,021

Other Site Activities

700

1

700

0.5

350

Board Member Characteristics

1,021

1

1,021

1.0

1,021

Request for Waiver of Governance Requirements

150

1

150

1.0

150

Compliance Matrix

1,021

1

1,021

.5

510.5

Health Center Affiliation Certification

250

1

250

.5

125

Health Center Affiliation Checklist

1,021

1

1,021

.5

510.5

Need for Assistance

900

1

900

6.0

5,400

Emergency Preparedness Form

1,021

1

1,021

1.0

1,021

FTCA Form

800

1

800

1.0

800

Points of Contact

800

1

800

.5

400

Total

1,021

15,131

52,686

Written comments and recommendations concerning the proposed information collection should be sent within 30 days of this notice to: Karen Matsuoka, Human Resources and Housing Branch, Office of Management and Budget, New Executive Office Building, Room 10235, Washington, DC 20503.

Dated: June 5, 2007.

Caroline Lewis,

Associate Administrator for Management.

[FR Doc. E7-11219 Filed 6-8-07; 8:45 am]

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