# 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: Uncompensated Services Assurance Report (OMB No. 0915-0077)—Revision**
Under the Hill-Burton Act, the Government provides grants and loans for construction or renovation of health care facilities. As a condition of receiving this construction assistance, facilities are required to provide services to persons unable to pay. A condition of receiving this assistance requires facilities to provide assurances periodically that the required level of uncompensated care is being provided, and that certain notification and record keeping procedures are being followed. These requirements are referred to as the uncompensated services assurance.
**Estimate of Information Collection Burden**
| Type of requirement and regulatory citation | Number of | Responses per respondent | Total | Hours per | Total hour |
| --- | --- | --- | --- | --- | --- |
| | | | | | |
| Published Notices (124.504(c)) | 206 | 1 | 206 | 0.17 | 35 |
| Individual Notices (124.504(c)) | 206 | 1 | 206 | 35.5 | 7,313 |
| Determinations of Eligibility (124.507) | 206 | 396 | 81,576 | 0.37 | 30,183 |
| Subtotal Disclosure Burden | | | | | 37,531 |
| Type of requirement and regulatory citation | Number of | Responses per | Total | Hours per | Total hour |
| --- | --- | --- | --- | --- | --- |
| | | | | | |
| Uncompensated Services Report—HRSA-710 Form (124.509(a)) | 10 | 1 | 10 | 11.0 | 110 |
| Application for Compliance Alternatives: | | | | | |
| Public Facilities (124.513) | 4 | 1 | 4 | 6.0 | 24 |
| Small Obligation Facilities (124.514(c)) | 0 | | | | |
| Charitable Facilities (124.516(c)) | 2 | 1 | 2 | 6.0 | 12 |
| Annual Certification for Compliance Alternatives: | | | | | |
| Public Facilities (124.509(b)) | 144 | 1 | 144 | 0.5 | 72 |
| Charitable Facilities (124.509(b)) | 28 | 1 | 28 | 0.5 | 14 |
| Small Obligation Facilities (124.509(c)) | 1 | 1 | 1 | 0.5 | 1 |
| Complaint Information (124.511(a)): | | | | | |
| Individuals | 10 | 1 | 10 | 0.25 | 3 |
| Facilities | 10 | 1 | 10 | 0.5 | 5 |
| Subtotal Reporting Burden | | | | | 241 |
| Recordkeeping | Number of Recordkeepers | Hours per year | Total hour |
| --- | --- | --- | --- |
| Non-alternative Facilities (124.510(a)) | 206 | 50 | 10,300 |
| Subtotal Recordkeeping Burden | | | 10,300 |
The total burden for this project is estimated to be 48,072 hours.
Written comments and recommendations concerning the proposed information collection should be sent within 30 days of this notice to: John Morrall, Human Resources and Housing Branch, Office of Management and Budget, New Executive Office Building, Room 10235, Washington, DC 20503.
Jane M. Harrison,
Director, Division of Policy Review and Coordination.