# 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, e-mail *[email protected]* or 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)—[Extension]**
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.
The annual estimate of burden is as follows:
| Instrument | Number of | Responses per | Total | Hours per | Total burden hours |
| --- | --- | --- | --- | --- | --- |
| | | | | | |
| Published Notices (124.504(c)) | 86 | 1 | 86 | 0.75 | 64.5 |
| Individual Notices (124.504(c)) | 86 | 1 | 86 | 43.6 | 3,749.6 |
| Determinations of Eligibility (124.507) | 86 | 99 | 8,514 | 0.75 | 6,385.50 |
| Subtotal disclosure burden | | | | | 10,199.60 |
| | | | | | |
| 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)) | 37 | 1 | 37 | 0.5 | 18.5 |
| Charitable Facilities (124.509(b)) | 14 | 1 | 14 | 0.5 | 7 |
| Small Obligation Facilities (124.509(c)) | 0 | 1 | 0 | 0.5 | 0 |
| Complaint Information (124.511(a)): | | | | | |
| Individuals | 10 | 1 | 10 | 0.25 | 2.5 |
| Facilities | 10 | 1 | 10 | 0.5 | 5 |
| Subtotal reporting burden | | | | | 179 |
| Recordkeeping | Number of | Hours per year | Total hour |
| --- | --- | --- | --- |
| Non-alternative Facilities (124.510(a)) | 86 | 50 | 4,300 |
| Subtotal recordkeeping burden | | | 4,300 |
The total burden for this project is estimated to be 14,678.60 hours. Written comments and recommendations concerning the proposed information collection should be sent within 30 days of this notice to the desk officer for HRSA, either by e-mail to *[email protected]* or by fax to (202) 395-6974. Please direct all correspondence to the “attention of the desk officer for HRSA.”
Dated: April 3, 2009.
Alexandra Huttinger,
Director, Division of Policy Review and Coordination.