Rural Health Care Services Outreach Performance Improvement and Measurement Systems (PIMS) Measures

Forms and Documents

Document Name	Status
Form 1 Rural Health Care Services Outreach Program Measures Form	Modified
FORHP_0906_0009_OMB NonSubstantive Change Request_04172025.docx Justification for No Material/Nonsubstantive Change	2025-05-09
Supporting Statement A - Outreach Program - revised 11.19.24.docx Supporting Statement A	2024-11-19

IC Document Collections

IC ID	Document Title	Status
215503	Rural Health Care Services Outreach Program Measures Form	Modified

ICR Details

OMB Control No: 0906-0009	ICR Reference No: 202505-0906-004
Status: Received in OIRA	Previous ICR Reference No: 202411-0906-001
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Rural Health Care Services Outreach Performance Improvement and Measurement Systems (PIMS) Measures
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/14/2025

	Requested	Previously Approved
Expiration Date	01/31/2028	01/31/2028
Responses	61	61
Time Burden (Hours)	488	488
Cost Burden (Dollars)	0	0

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Abstract: The PIMS measures for the Outreach Program enable HRSA and the Federal Office of Rural Health Policy to capture awardee-level and aggregate data that illustrate the impact and scope of federal funding. The collection of this information helps further inform and substantiate the focus and objectives of the grant program. The respondents would be award recipients of the Rural Health Care Services Outreach Program.

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Authorizing Statute(s): US Code: 42 USC 254c(e) Name of Law: Section 330A (e) of the Public Health Service (PHS) Act
   PL: Pub.L. 116 - 136 330A(e), Title III Name of Law: PHSA
  

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:
	89 FR 52069	06/21/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 91412	11/19/2024
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 Care Services Outreach Program Measures	1	Rural Health Care Services Outreach Program.docx

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ICR Summary of Burden

	Total Request	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	61	61	0	0	0	0
Annual Time Burden (Hours)	488	488	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $15,133

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? No

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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: 05/14/2025

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