Rural Public Health Workforce Training Network Program (RPHWTN)

Forms and Documents

Document Name	Status
Form 4 Trainee Survey Form	Modified
Form 3 Grantee Exit Survey Form	Modified
Form 2 Grantee Follow-up Survey Form	Modified
Form 1 Grantee Baseline Survey Form	Unchanged
FORHP_0915-0392_OMB NonSubstantive Change Request_05012025.docx Justification for No Material/Nonsubstantive Change	2025-05-09
Supporting Statement A_RPHWNTP_Final _07.27.23-OIRA_OPAErevisions_clean.docx Supporting Statement A	2023-08-11
Attachment6_M-21-20.pdf Supplementary Document	2023-05-30
Attachment1_HRSA-22-117-RPHWTNP-NOFO.pdf Supplementary Document	2023-05-30

IC Document Collections

IC ID	Document Title	Status
260417	Trainee Survey Form	Modified
260416	Grantee Exit Survey Form	Modified
260415	Grantee Follow-up Survey Form	Modified
260414	Grantee Baseline Survey Form	Unchanged

ICR Details

OMB Control No: 0915-0392	ICR Reference No: 202505-0915-001
Status: Received in OIRA	Previous ICR Reference No: 202305-0915-006
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Rural Public Health Workforce Training Network Program (RPHWTN)
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	08/31/2026	08/31/2026
Responses	1,128	1,128
Time Burden (Hours)	274	274
Cost Burden (Dollars)	0	0

---

Abstract: The Rural Public Health Workforce Training Network (RPHWTN) Program Data Collection is authorized by Section 330A(f) of the Public Health Service Act (42 U.S.C. 254c(f)). Furthermore, section 2501 of the American Rescue Plan Act of 2021 (ARP, Pub. L. 117–2) provides funding for the Department of Health and Human Services to carry out activities related to expanding and sustaining a public health workforce, including to respond to COVID-19. The RPHWTN program, which is managed by the Federal Office of Rural Health Policy at HRSA, intends to expand public health capacity by supporting health care job development, training, and placement in rural communities. This grant program intends to address the ongoing critical need for trained public health professionals in health care facilities serving rural communities by establishing networks that will develop formal training/certification programs. The long-term objective of this program is to enhance clinical and operational capacity to adequately address population health needs of rural communities negatively impacted by COVID-19, including long COVID-19. The HRSA Office of Planning, Analysis, and Evaluation will work with the Federal Office of Rural Health Policy to design and distribute surveys to RPHWTN grantees and trainees, which will serve as program data collection tools. Grantees will establish networks that support health care job development, training, and placement in rural communities. Trainees are individuals participating in the training programs made possible through the RPHTWN-supported networks established by program grantees. To accomplish RPHWTN program goals, HRSA would like to collect the following type of information from respondents: • From grantees: training content, count of trainings and attendees, specific strategies in supporting patients with long COVID-19 and behavioral health needs, and trainee retention/ completion. • From trainees: limited demographic information (age, ZIP code, race, and ethnicity), skills needed to fulfill roles in specific tracks selected, skill assessment, professional and/or educational experience, and career goals/intentions.

---

Authorizing Statute(s): PL: Pub.L. 117 - 2 2501 Name of Law: American Rescue Plan Act of 2021
   PL: Pub.L. 115 - 435 101 Name of Law: Foundations for Evidence-Based Policymaking Act of 2018
   US Code: 42 USC 254c(a) Name of Law: Public Health Service Act (42 U.S.C. §§ 201-291n)
   US Code: 42 USC 254c(f) Name of Law: Public Health Service Act (42 U.S.C. §§ 201-291n)
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 75639	12/09/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 34507	05/30/2023
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Grantee Baseline Survey	1	Grantee Baseline Survey
Grantee Exit Survey	3	Grantee Exit Survey
Grantee Follow-up Survey	2	Grantee Follow-up Survey
Trainee Survey	4	Trainee Survey

---

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	1,128	1,128	0	0	0	0
Annual Time Burden (Hours)	274	274	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:

---

Annual Cost to Federal Government: $123,997

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

---

Common Form ICR:  No

---

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

---