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Agency Information Collection Activities: Proposed Collection: Public Comment Request; Information Collection Request Title: Health Center Program Forms-OMB No. 0915-0285-Revision

In compliance with the requirement for opportunity for public comment on proposed data collection projects of the Paperwork Reduction Act of 1995, HRSA announces plans to submit...

Department of Health and Human Services
Health Resources and Services Administration

AGENCY:

Health Resources and Services Administration (HRSA), Department of Health and Human Services.

ACTION:

Notice.

SUMMARY:

In compliance with the requirement for opportunity for public comment on proposed data collection projects of the Paperwork Reduction Act of 1995, HRSA announces plans to submit an Information Collection Request (ICR), described below, to the Office of Management and Budget (OMB). Prior to submitting the ICR to OMB, HRSA seeks comments from the public regarding the burden estimate, below, or any other aspect of the ICR.

DATES:

Comments on this ICR should be received no later than September 28, 2026.

ADDRESSES:

Submit your comments to or mail the HRSA Information Collection Clearance Officer, Room 13N82, 5600 Fishers Lane, Rockville, Maryland 20857.

FOR FURTHER INFORMATION CONTACT:

To request more information on the ( printed page 48171) proposed project or to obtain a copy of the data collection plans and draft instruments, email or call Samantha Miller, the HRSA Information Collection Clearance Officer, at (301) 443-3983.

SUPPLEMENTARY INFORMATION:

Information Collection Request Title: Health Center Program Forms, OMB No. 0915-0285—Revision.

Abstract: The Health Center Program, administered by HRSA, is authorized under Section 330 of the Public Health Service Act (42 U.S.C. 254b). Health centers are patient-directed organizations that deliver affordable, accessible, quality, and cost-effective primary health care services to patients and adjust fees based on income and family size. Nearly 1,400 health centers operate more than 16,000 service delivery sites that provide primary health care to more than 32 million people in every U.S. state, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin. HRSA uses forms for health centers to report progress and change their scope of project.

Need and Proposed Use of the Information: The information HRSA collects from health centers via the Health Center Program-specific forms is necessary for the agency's oversight of Health Center Program awards. HRSA uses the information for program monitoring and for evaluating award recipients' compliance with Health Center Program statutory and regulatory requirements. These forms were approved by OMB on May 31, 2026, following 60- and 30-day public comment periods. Eight forms that were previously approved are being updated and three forms are being added to facilitate monitoring, improve scope of project documentation and oversight, increase the efficiency of the change in scope process, and enhance the accuracy of change in scope requests.

HRSA will modify the following forms to update and clarify data currently being collected:

Forms proposed to be modified: number/name Description of modifications
Form 5A: Services Provided Update labels and categories of services.
Form 5B: Sites Modify fields collecting site information.
Checklist for Form 5A Scope Adjustments Revise checklist statements and questions.
Checklist for Form 5B Scope Adjustments Revise checklist statements and questions.
Checklist for Deleting a Service Site from Scope Previously: Checklist for Deleting Existing Service Delivery Site. Revise checklist statements and questions.
Checklist for Adding a Service Site to Scope Previously: Checklist for Adding a New Service Delivery Site. Revise checklist statements and questions.
Checklist for Adding a Service to Scope Previously Checklist for adding a new service. Revise checklist statements and questions.
Checklist for Deleting a Service from Scope Previously: Checklist for deleting existing service. Revise checklist statements and questions.

HRSA will add the following forms necessary for data collection and change in scope requests to simplify the process:

Likely Respondents: Health Center Program award recipients (those funded under section 330 of the Public Health Service Act) and Health Center Program look-alikes.

Burden Statement: Burden in this context means the time expended by persons to generate, maintain, retain, disclose, or provide the information requested. This includes the time needed to review instructions; to develop, acquire, install, and utilize technology and systems for the purpose of collecting, validating and verifying information, processing and maintaining information, and disclosing and providing information; to train personnel and to be able to respond to a collection of information; to search data sources; to complete and review the collection of information; and to transmit or otherwise disclose the information. The total annual burden hours estimated for this ICR are summarized in the table below.

These updates will reduce the estimated annual burden by 1,483.50 hours compared with the burden approved in the ICR on May 31, 2026. This is due to the modification of existing forms that is expected to reduce burden. In the burden table below, new forms are indicated through bold text, and revised forms are indicated through italicized text. All other forms are unchanged.

Total Estimated Annualized Burden Hours

Form title Number of respondents Number of responses per respondent Total responses Average burden per response (hours) Total burden hours
Form 5A: Services Provided 1,400 1 1,400 0.25 350.00
Form 5B: Sites 1,400 1 1,400 0.25 350.00
Checklist for Form 5A Scope Adjustments 1,000 1 1,000 1.00 1,000.00
Checklist for Form 5B Scope Adjustments 2,000 1 2,000 1.00 2,000.00
Checklist for Deleting a Service Site from Scope. Previously: Checklist for Deleting Existing Service Delivery Site 500 1 500 1.00 500.00
Checklist for Adding a Service Site to Scope. Previously: Checklist for Adding a New Service Delivery Site 1,250 1 1,250 1.50 1,875.00
Checklist for Adding a Service to Scope. Previously: Checklist for adding a new service 450 1 450 1.00 450.00
Checklist for Deleting a Service from Scope. Previously: Checklist for deleting existing service 500 1 500 1.00 500.00
Checklist for Replacing a Service Site in Scope 250 1 250 0.75 187.50
( printed page 48172)
QIF Final Report 25 1 25 3.00 75.00
Loan Guarantee Progress Report 22 4 88 1.00 88.00
Capital Semi-Annual Progress Report 500 2 1,000 1.00 1,000.00
Equipment List 130 1 130 0.50 65.00
Federal Object Class Categories Form 500 1 500 0.25 125.00
Loan Guarantee Program Financial Performance Indicators 5 1 5 1.00 5.00
Form 1A: General Information Worksheet 1,370 1 1,370 0.75 1,027.50
Form 1B: Funding Request Summary 900 1 900 0.75 675.00
Form 1C: Documents on File 1,460 1 1,460 0.50 730.00
Form 2: Staffing Profile 1,370 1 1,370 1.00 1,370.00
Form 3: Income Analysis 1,370 1 1,370 1.00 1,370.00
Form 5C: Other Activities/Locations 550 1 550 0.25 137.50
Form 6A: Current Board Member Characteristics 1,370 1 1,370 1.00 1,370.00
Form 6B: Request for Waiver of Board Member Requirements 1,370 1 1,370 1.00 1,370.00
Form 8: Health Center Agreements 1,370 1 1,370 1.00 1,370.00
Form 12: Organization Contacts 970 1 970 0.50 485.00
Funding Sources 130 1 130 0.50 65.00
FY 2022 Accelerating Cancer Screening Progress Report 29 1 29 1.50 43.50
Grant Number Form 400 1 400 0.25 100.00
HCCN Progress Report 50 1 50 0.50 25.00
Health Center Program Progress Report 130 1 130 1.00 130.00
HRSA Loan Guarantee Program Application 5 1 5 1.00 5.00
Impact Form 400 1 400 1.00 400.00
NHHCIA NCC Clinical Performance Measures 5 1 5 1.50 7.50
NHHCIA NCC Financial Performance Measures 5 1 5 0.50 2.50
NHHCIA NCC Income Analysis Form 5 1 5 0.15 0.75
NHHCIA Sample Project Work Plan 2 1 2 0.15 0.30
NH-NCC Project Work Plan Update 5 1 5 1.00 5.00
Operational Plan 350 1 350 2.00 700.00
Other Requirements for Sites 130 1 130 0.50 65.00
Participating Health Centers List 90 1 90 1.00 90.00
Project Cover Page 130 1 130 1.00 130.00
Project Narrative Update 1,325 1 1,325 4.00 5,300.00
Project Overview Form 500 1 500 1.00 500.00
Project Qualification Criteria 130 1 130 0.50 65.00
Project Work Plan 508 1 508 4.00 2,032.00
Proposal Cover Page 130 1 130 1.00 130.00
QIF Evaluative Measures Report 25 2 50 1.50 75.00
QIF Progress Report 25 12 300 1.50 450.00
QIF TJI Evaluative Measures Report 54 10 540 1.50 810.00
QIF TJI Progress Report 54 10 540 1.50 810.00
QIF Project Plan Form 100 1 100 1.00 100.00
Summary Page (New Access Point) 500 1 500 1.00 500.00
Summary Page (Service Area Competition) 360 1 360 0.50 180.00
LAL Cover page 110 1 110 0.50 55.00
Checklist for Adding a Transitional Care in a Carceral Setting Site to Scope 50 1 50 1.00 50.00
Totals 27,769.00 29,607.00 31,302.05

HRSA specifically requests comments on: (1) the necessity and utility of the proposed information collection for the proper performance of the agency's functions; (2) the accuracy of the estimated burden; (3) ways to enhance the quality, utility, and clarity of the information to be collected; and (4) the use of automated collection techniques or other forms of information technology to minimize the information collection burden.

Maria G. Button,

Director, Executive Secretariat.

[FR Doc. 2026-15419 Filed 7-29-26; 8:45 am]

BILLING CODE 4165-15-P

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91 FR 48170

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“Agency Information Collection Activities: Proposed Collection: Public Comment Request; Information Collection Request Title: Health Center Program Forms-OMB No. 0915-0285-Revision,” thefederalregister.org (July 30, 2026), https://thefederalregister.org/documents/2026-15419/agency-information-collection-activities-proposed-collection-public-comment-request-information-collection-request-title.