Agency Information Collection Activities: Proposed Collection: Comment Request

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, Public Law 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, call the HRSA Reports Clearance Officer on (301) 443-1129.

Comments are invited on: (a) Whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information shall have practical utility; (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 Revision)

HRSA's Bureau of Primary Health Care (BPHC) 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. FQHCs are administered by HRSA's BPHC.

HRSA uses the following application forms to administer and manage FQHCs. These application forms are used by new and existing FQHCs to apply for grant and non-grant opportunities, re-new their grant or non-grant opportunities, or change their scope of project.

Estimated of annualized reporting burden are as follows:

Type of application form

Number of respondents

Responses per respondent

Total number of 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

Institutional File Assurances

1,021

1

1,021

0.5

510

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

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

0.5

510

Health Center Affiliation Certification

250

1

250

0.5

125

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

0.5

400

Total

15,131

15,131

52,684

Send comments to Susan G. Queen, Ph.D., HRSA Reports Clearance Officer, Room 14-33, Parklawn Building, 5600 Fishers Lane, Rockville, MD 20857. Written comments should be received within 60 days of this notice.

Dated: March 27, 2007.

Alexandra Huttinger,

Acting Director, Division of Policy Review and Coordination.

[FR Doc. E7-6089 Filed 4-2-07; 8:45 am]

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