[Federal Register Volume 77, Number 214 (Monday, November 5, 2012)]
[Notices]
[Pages 66471-66476]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-26938]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Methodology for Designation of Frontier and Remote Areas

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Request for public comment on methodology for designation of 
frontier and remote areas.

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SUMMARY: This notice announces a request for public comment on a 
methodology derived from the Frontier and Remote (FAR) system for 
designating U.S. frontier areas. This methodology was developed in a 
collaborative project between the Office of Rural Health Policy (ORHP) 
in the Health Resources and Services Administration (HRSA); and the 
Economic Research Service (ERS) in the U.S. Department of Agriculture 
(USDA). While other agencies of the Department of Health and Human 
Services (HHS) and the ERS may in the future choose to use the FAR 
methodology to demarcate the frontier areas of the U.S., there is no 
requirement that they do so, and they may choose other, alternate 
methodologies and definitions that best suit their program 
requirements.

DATES: The public is encouraged to submit written comments on the 
proposed FAR methodology no later than January 4, 2013. All public 
comments received will be available for public inspection at HRSA's 
ORHP on weekdays between 8:30 a.m. and 5:00 p.m.

ADDRESSES: Comments may be submitted via email to shirsch@hrsa.gov; 
mail to Office of Rural Health Policy, Health Resources and Services 
Administration, 5600 Fishers Lane, Parklawn Building, 5A-05, Rockville, 
MD 20857; or fax to (301) 443-2803.

FOR FURTHER INFORMATION CONTACT: Questions about this request for 
public comment can be directed to Steven Hirsch using the contact 
information listed above.

SUPPLEMENTARY INFORMATION:

Background

    ORHP was authorized by Congress in December of 1987 by Section 711 
of the Social Security Act [42 U.S.C. 912], and charged with informing 
and advising HHS on matters affecting rural hospitals and health care 
and coordinating activities within the Department that relate to rural 
health care.
    Definition of ``rural.'' ORHP considers all nonmetropolitan 
(nonmetro) counties to be ``rural'' for the purposes of eligibility for 
its grant programs. Over the years, ORHP has funded development of a 
rational, data-driven method to designate rural areas inside of 
metropolitan counties. The Rural-Urban Commuting Area (RUCA) codes are 
used for determining grant eligibility. The RUCAs, which were developed 
by Richard Morrill and Gary Hart of the University of Washington and 
John Cromartie of the USDA's ERS, are based on a sub-county unit, the 
census tract, permitting a delineation of what constitutes rural areas 
inside metropolitan areas (see: http://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes.aspx). Using data from the Census 
Bureau, every census tract in the United States is assigned a RUCA 
code. Codes range from 1 through 10, with 23 sub codes, with code 1 
representing the most densely populated urban areas and code 10 
representing rural areas with primary commuting to a tract outside an 
Urbanized Area or Cluster. HRSA believes that the use of RUCAs allows 
more accurate targeting of resources intended for the rural population. 
Both ORHP and the Centers for Medicare & Medicaid Services have been 
using RUCAs for several years to determine programmatic eligibility for 
rural areas inside of metropolitan counties.
    ORHP currently considers all census tracts with RUCA codes 4 
through 10 to be rural. While use of the RUCA codes has allowed 
identification of rural census tracts in metropolitan counties, among 
the more than 60,000 tracts in the U.S., there are some that are 
extremely large and where use of RUCA codes alone fails to account for 
distance to services and sparse population. In response to these 
concerns, ORHP has designated 132 large area census tracts with RUCA 
codes 2 or 3 as rural. These tracts are at least 400 square miles in 
area with a population density of no more than 35 people per square 
mile. There is also a ZIP code-based version of the RUCA codes that is 
often used for policy analysis, research, and other purposes (see: 
http://depts.washington.edu/uwruca/).
    Need for definition of ``frontier and remote.'' Rural experts, 
researchers, and others have been calling for an improved way to 
identify frontier and remote areas. The most commonly used standard to 
date has been to identify frontier areas as those counties with six or 
fewer people per square mile. Researchers and policy experts have noted 
the shortcomings of this approach since it relies solely on population 
density and uses counties as the unit of measure despite the great 
disparity in

[[Page 66472]]

county size across the country (Ciarlo, 1996). This definition lacks 
precision. Demand has been growing for a statistically based, 
nationally consistent definition of ``frontier territory;'' one that is 
adjustable within a reasonable range, and applicable in different 
research and policy contexts. The U.S. Congress passed legislation 
directing the Secretary of HHS to issue regulations that would define 
the concept of ``Frontier Area'' to be used in the Telehealth programs 
(Section 330I(r) of the Public Health Service Act, 42 U.S.C. 254c-
14(r)). The definition proposed below differs in several respects from 
the statutory provision governing the Telehealth programs, and thus it 
will not be applicable to them. As used in this notice, the term 
``frontier'' denotes territory characterized by some combination of 
relatively low population density and high geographic remoteness.
    In performing analysis for this project, HRSA intended to create a 
definition of ``frontier'' based on easily explained concepts of 
remoteness and population sparseness. HRSA's goal was to create a 
statistical delineation that will be useful in a wide variety of 
research and policy contexts and adjustable to the circumstances in 
which it is applied. We believe that the new geographic taxonomy should 
prove useful in various research and policy environments, such as rural 
health care, regional science, demography, rural sociology, and 
agricultural economics. Two features distinguish the methodology 
described here from earlier classifications. First, the approach 
strives for the most accurate measures of distance possible for the 
smallest units of geography containing population data. Travel time by 
car to nearby urban areas is calculated for coterminous U.S. territory 
at the 1x1 kilometer grid level (11.9 million grid cells). Once 
frontier territory is delimited at the grid level, frontier populations 
may be aggregated to ZIP code areas, as demonstrated here, or to census 
tracts, counties, or other useful geographic units. Second, travel time 
thresholds around urban areas were allowed to vary by urban-area 
population size. This is desirable because the effect of urban 
population size on adjacent rural population density is not uniform 
across all urban sizes. In general, the higher the population of an 
urbanized area, the greater the population density of any given area 
nearby.
    However, any statistical delineation of this nature is approximate 
at best, and not suited to all applications. Given the remarkable 
diversity of settlement patterns and conditions across the contemporary 
U.S., no definition can account for every variation; and there will be 
areas included or excluded that would seem to many to be erroneously 
classified. Therefore, it is necessary to build some degree of 
flexibility into any definition that will allow users to choose the 
sub-definition that best suits their purpose. The FAR codes described 
here allow a range of choices rather than a dichotomy. It will be up to 
researchers, policymakers, program managers, and policy advocates to 
ensure that the codes are applied appropriately within specific 
contexts.

Why is it important to delineate frontier areas?

    This project seeks to delineate U.S. territory characterized by 
very low population density and a high degree of remoteness. Such 
territory lies at one end of the rural-urban continuum and can be 
generally viewed as a subset of rural. Job creation, population 
retention, provision of services such as health care, and access to 
food, clothing, and other consumer items may require increased efforts 
in very rural, remote communities. Recent research indicates that the 
demographic and economic penalties associated with small size and 
remoteness may be increasing (Partridge, 2008).
    Perhaps the fundamental and defining challenges facing frontier 
communities are the increased per capita costs of providing services. 
Access to health care is a primary concern motivating this research, 
but distance and low population densities increase costs of providing 
all types of social and public services, including schools, police and 
fire protection, public utilities, and transportation.

Placing Frontier Definitions in a Broader Rural Context

    For purposes of this project, ``frontier/remote'' is generally 
considered a subset of ``rural.'' Of course, there are many definitions 
of ``rural'' and as much disagreement about them as there is about 
frontier. Many of the rural taxonomies have multiple categories, some 
of which can be used and evaluated for their utility in designating 
frontier/remote areas. Only by defining ``rural'' appropriately can 
policymakers better understand the implications of certain policy 
options. The definition of rurality used for one purpose may be 
inappropriate or inadequate for another (Larson and Hart, 2003).
    Most of the rural definitions are based on counties (or their 
equivalents) as the geographic unit. The most important reasons for 
using counties include that they: (1) Have much available data; (2) are 
significant political entities; (3) seldom change boundaries; (4) are 
traditionally used in many reporting systems and data sets; and (5) are 
well known to the general public, program managers, researchers, and 
politicians. However, there are significant problems with county use 
for many purposes. Counties were created by means of political 
processes and often are extremely heterogeneous units where aggregate 
averages of data items end up being unrepresentative of particular 
places within the county. The rural/urban character within many 
counties varies dramatically. For instance, Pima County, Arizona, 
ranges from an urban city of over half a million population near its 
northeast corner to large remote areas that are extremely sparsely 
populated along its southwest Mexico/U.S. border. Some large states 
like Arizona (114,006 square miles--significantly larger than the 
United Kingdom) have few counties (17 counties), while smaller states 
like Virginia (42,769 square miles) have many smaller counties (134 
counties). Counties vary in size from state to state, with the counties 
in the west generally much larger than those of the east.
    Some definitions go beyond a simple division of counties into 
rural/urban or metro/nonmetro categories. For instance, the ERS' 
county-based Urban Influence Codes (UICs) consist of a dozen codes and 
uses the Office of Management and Budget's definition of metropolitan 
to divide the nation's urban-like and rural-like counties into two 
groups. The taxonomy divides the nonmetro counties into 10 categories. 
The most frontier-like of these categories (i.e., category number 12) 
could be considered as possible frontier/remote areas, but because it 
uses a county level analysis, the use of UIC still mischaracterizes 
some areas within counties that have a high degree of heterogeneity in 
terms of their degree of being frontier/rural.
    ``The choice of definition for `rural' that is used to present 
demographic and health data can make a substantive difference. For 
example, whether a disproportionate number of rural residents are 
elderly depends on how rural is defined. Furthermore, wide variations 
in health status indicators within non-metro areas will not be apparent 
unless non-metro data are disaggregated by region, urbanization, 
proximity to urban areas, or other relevant factors,'' (Hewitt, 1989).
    Depending on which categorization is chosen, estimates of the rural 
population of the U.S. can vary widely. Such differences make reported 
information vastly different depending

[[Page 66473]]

on which definition is employed. Although having ``rural'' definitions 
that differ in geographic units and criteria is not inherently bad 
because they may be used for different purposes, this example does 
demonstrate that they can lead to considerably different populations 
being designated.
    There are some taxonomies that are based on sub-county units. The 
oldest and most used such geographic taxonomy is that of the U.S. 
Census Bureau. This utilizes census tract and block group data to 
define Urbanized Areas and Urban Clusters (described below). The other 
taxonomy that has gained significant use, especially related to health 
care, is the RUCAs, which were described above.
    There are many different types of ``rural'' and ``frontier'' 
definitions. Many of these definitions were developed in response to 
specific needs, but this is not always considered when they are applied 
to other tasks and different purposes. Deciding which ``rural'' 
definition to apply to a research or policy analysis topic depends on 
the purpose at hand, the availability of data, and the appropriate and 
available taxonomy. All currently available definitions of ``rural'' 
have their limitations, however the approach described in this notice 
is intended to provide an empiric approach to the definition of 
``frontier'' and ``remote.'' Although it is unlikely that all 
researchers, analysts, and advocates will ever agree that a single 
definition of ``rural'' is appropriate in all circumstances, we believe 
that the approach below may provide interested parties with an 
additional instrument to gauge the relative rurality of an area.

General Review of the Frontier Concept

    The ``frontier'' definition discussed here is a geographical 
concept meant to delineate areas characterized primarily by remoteness. 
Applying this particular meaning to the term has increased in recent 
years, especially in the rural health policy arena, and represents a 
natural evolution of the term with parallels in other disciplines (as 
described below). Though a more neutral label, such as ``remote areas'' 
could easily be substituted, there are benefits to use of the term 
``frontier'' for several reasons, one being the use of a shorter, more 
intuitively appealing descriptive label in research publications and 
other outlets.
    For geographers and others, the term ``frontier'' came to mean not 
just the line dividing more densely settled and less densely settled 
territory, but all of the less densely settled territory beyond the 
line. For example, after the 1980 Census, Frank Popper published a 
series of academic and news articles in which he applied the term 
frontier to all sparsely settled territory, as many others were doing, 
and his research showed that more than half the land area of the U.S. 
was still frontier. He also claimed that the number of frontier 
communities was growing because of persistent population loss 
throughout the nation's heartland (Popper, F.J., 1986). Social 
scientists and others are increasingly using the term ``frontier'' to 
describe sparsely settled and geographically remote territory, 
especially in the U.S. (Duncan, 1993; McGranahan and Beale, 2002). On 
the federal and state health care front, frontier came to have a 
general meaning similar to that advocated by Popper (i.e., sparsely 
settled) with remoteness often emphasized. ``In the mid-1980s, the 
federal Community Health Center program decided to consider as frontier 
those counties with a population less than or equal to six persons per 
square mile located at considerable distance (greater than 60 minutes 
travel time) to a medical facility able to perform a caesarian section 
delivery or handle a patient having a cardiac arrest. These latter 
criteria were forgotten through the years, and programs began to define 
frontier counties with only a single criteria--population density of 
six persons per square mile or less,'' (Definition of Frontier section 
of following web page accessed 4/21/2011: http://frontierus.org/defining.php). For a bibliography, demographics, federal programs, and 
other materials related to frontier, see the National Center for 
Frontier Communities Web site (http://frontierus.org/).
    It is clear from an overview of the literature that a fairly small 
group of factors have a tendency to be included in most of the rural 
and frontier taxonomies. The Census Bureau used population density 
(areas of less than two people per square mile) exclusively in its 19th 
century definition. In contemporary applications, geographic remoteness 
has been equally emphasized. For instance, McGranahan and Beale (2002) 
identified a set of frontier counties based on two measures applied to 
nonmetro counties: Population density (less than 10.1 persons per 
square mile) and non-adjacency to a metro area as a proxy for 
remoteness. Many other measures attempt to capture these overlapping 
but distinct concepts of sparseness and remoteness: population size, 
distance to urban areas (measured in linear miles, travel miles, or 
travel time), and degree of urbanization.
    Many of the listed factors have a face validity that is quite 
obvious. For instance, society's perception of rural areas is that they 
are those places where the population settlement pattern demonstrates 
low density (i.e., sparsely settled areas).

Geographic Taxonomy Development Concerns

    The ORHP/ERS-funded frontier taxonomy project to develop a needed 
national definition of ``frontier'' and ``remote'' was started in 2008, 
and included the following components:
    (1) Creation of a comprehensive review and inventory of rural and 
frontier definitions;
    (2) Establishment and use of a Technical Advisory Group (five 
academic experts), conference calls, and other communication and 
feedback;
    (3) Formation and use of a Stakeholder Advisory Group (seven 
relevant stakeholders), conference calls, and other communications and 
feedback;
    (4) Planning and implementing five regional stakeholder meetings in 
Washington (District of Columbia), Albuquerque (New Mexico), Omaha 
(Nebraska), and two in Seattle (Washington)--one of which was more 
specifically about islands. Meetings were limited to approximately 30 
stakeholders. In addition, many other presentations with time for 
feedback were made (e.g., presentations to the Frontier Partners 
Group);
    (5) Analytical testing of the alternate approaches and results;
    (6) Solicitation of feedback regarding approaches and results;
    (7) Selection of final methodological approach; and
    (8) Analyses using final methodology on 2000 data.
    All the components have been completed.

Frontier and Remote (FAR) Methodology

    To assist in providing policy-relevant information about conditions 
in remote areas to policymakers, public officials, researchers, and the 
general public, ORHP has helped fund the development of a set of ZIP 
code-level frontier codes by ERS.
    The term ``frontier'' is used here to describe territory 
characterized by some combination of low population size and high 
geographic remoteness. This pilot FAR version, based on 2000 Census 
data, provides four separate frontier definitions (Levels), ranging 
from one that is relatively inclusive (18.0 million people classified 
as living in frontier areas) to a relatively restrictive version

[[Page 66474]]

(4.8 million frontier residents). Different definitions are necessary 
because rural areas experience degrees of remoteness at differing 
population levels that affect access to different types of goods and 
services. A relatively large share of the population live far from 
cities providing ``high-order'' goods and services, such as advanced 
medical procedures, major household appliances, regional airport hubs, 
or professional sports franchises. A much smaller, but still 
significant, share of U.S. residents finds it hard to access ``low-
order'' goods and services, such as grocery stores, gas stations, and 
basic health care needs. Other types of goods and services--clothing 
stores, car dealerships, movie theaters--fall somewhere in between.
    Calculation of travel times from urban areas was performed for 1x1 
kilometer grid cells that also included an estimated 2000 Census 
population. The use of these small, 1 square kilometer cells, allows 
more accuracy of measurement than use of larger units, such as census 
tracts or county boundaries. Once the frontier status for all grid 
cells was determined, the grid-cell population was aggregated to ZIP 
code areas. For each of the four frontier Levels, the percentage of a 
ZIP code area's population classified as frontier was determined. If 
the majority of the ZIP code areas' population was classified as 
frontier, that ZIP code area was considered to be a frontier area.
    Use of the FAR Methodology and associated data can be used to 
generate alternative ``frontier'' definitions that might better fit 
potential user purposes. The FAR codes can also be used in conjunction 
with other data, such as socioeconomic characteristics of populations, 
to allow further research analysis or better policy use.
    A synopsis of the methods for the new FAR definition is as follows:
    (1) The developmental analyses were based on the 2000 Bureau of the 
Census data;
    (2) the conterminous U.S. was divided into 11.9 million 1x1 
kilometer squares for analysis;
    (3) settlement population aggregations were based on the Census 
Bureau's designated Urbanized Areas and Urban Clusters based on the 
2000 Census data;
    (4) travel times were calculated to the nearest edges of Urbanized 
Areas of 2500 or greater population (travel times were estimated using 
speed limits and the fastest routes were determined and employed in the 
analyses);
    (5) travel times were calculated to the nearest Urbanized Areas 
regarding each of the following categories: 50,000 or greater 
population, 25,000-49,999 population, 10,000-24,999 population, and 
2,500-9,999 population;
    (6) for each of the 11.9 million grid cells, the information in 
4 and 5 above were used to determine frontier status 
for each of the four levels (described below);
    (7) the grid-cell populations (now classified as frontier or non-
frontier) were then aggregated to ZIP code areas (ZIP code areas used 
here come from an ESRI map boundary file reflecting the U.S. Postal 
Service December 2010 inventory); and
    (8) ZIP code areas were assigned as being FAR or not based on 
whether 50 percent or more of the populations in their cells were 
designated as FAR (this was performed for each of the four Level 
criteria--described below).
    Not only can the cell data be aggregated and calculated for ZIP 
code areas, but also the same is being done for census tracts and could 
be done for other types of geographic units. Note that aggregating the 
information to larger geographic units (such as counties and states) 
creates many more units that combine both frontier and non-frontier 
populations.
    The four FAR Levels are defined as follows (travel times are 
calculated one-way by the fastest paved road route):
    (1) Frontier Level 1 areas are 60 minutes or greater from Census 
Bureau-defined Urban Areas of 50,000 or more population;
    (2) Frontier Level 2 areas are 60 minutes or greater from Urban 
Areas of 50,000 or more people and 45 minutes or greater from Urban 
Areas of 25,000-49,999;
    (3) Frontier Level 3 areas are 60 minutes or greater from Urban 
Areas of 50,000 or more people; 45 minutes or greater from Urban Areas 
of 25,000-49,999; and 30 minutes or greater from Urban Areas of 10,000-
24,999; and
    (4) Frontier Level 4 areas are 60 minutes or greater from Urban 
Areas of 50,000 or more people; 45 minutes or greater from Urban Areas 
of 25,000-49,999; 30 minutes or greater from Urban Areas of 10,000-
24,999; and 15 minutes or greater from Urban Areas of 2,500-9,999.
    FAR Level 1 includes a larger proportion of the population and land 
area of the U.S than Level 2, which includes more area and population 
than Level 3, etc. Thus, a ZIP code area that is designated as FAR per 
the Level 2 definition would need to be located an hour or more travel 
time from the nearest edge of the closest Urbanized Area (50,000 or 
more population), and also be located 45 minutes travel time from the 
nearest edge of an Urban Area of 25,000-49,999 population. For 
instance, if a ZIP code area was 70 minutes from an Urban Area of 
105,000 population and 55 minutes from an Urban Area of 37,000, it 
would qualify as FAR, but if it was 70 minutes from an Urbanized Area 
of the same population and 29 minutes from an Urban Area of the same 
size it would not be designated as FAR. Because the base cell 
information used for the conterminous states was not available for 
Alaska and Hawaii, the designation process has to be modified and 
performed in a more tailored and analyst-intensive fashion. A trial of 
this method indicates that the final designations for these two states 
will be for all intents and purposes parallel with those of the other 
48 states. The final version of the designations for Alaska and Hawaii 
will be performed when the 48 states are redone with the Census 
designation of Urban Areas with 2010 data.
    Not all cells and populations are connected to larger places by 
roads. In many cases, other means of transportation must be utilized 
(e.g., airplanes, trains, ferries, ships, and boats). This is not only 
true for the many islands of Hawaii and Alaska, but for many of the 
other states (e.g., Washington's San Juan Islands in the Puget Sound 
and Massachusetts' Nantucket Island). There are also towns such as 
Alaska's Bethel that are not connected to larger towns/cities by roads 
(i.e., in this case only by air). In these cases (e.g., where air 
flights are necessary), one hour is added to the road travel time for 
the area, which is more than enough for an area to be designated as FAR 
if it can qualify by specific definition level criteria (e.g., to 
qualify for Level 3, the town would need to have fewer than 10,000 
population). For example, Kauai's largest city is Kappa with a 2010 
population of 10,699. The entire island clearly qualifies as frontier 
per FAR Level 1 and Level 2 definitions. Large portions of the island 
(but not all of it) also qualify per the FAR Level 3 (i.e., a portion 
of Kauai's population reside greater than 30 minutes travel from a city 
of over 10,000) and Level 4 definitions. Bethel, Alaska, which is not 
connected to other cities and towns via road with a 2010 population of 
17,013, also qualifies as frontier per the FAR Level 1 and Level 2 
definitions but not by the FAR Level 3 and Level 4 definitions (i.e., 
the city has greater than 10,000 population), though surrounding areas 
would qualify because of the severe travel barriers (i.e., no roads 
into town).
    Given that different geographical units (e.g., residential ZIP code 
areas,

[[Page 66475]]

census tracts etc.) would aggregate areas differently, a small Gulf 
island 100 yards off Florida with no connecting bridge might qualify 
differently using different geographic units. As indicated above, the 
FAR designations for ZIP code areas were based on a criterion of 50 
percent or greater being designated. Data will be made available so 
that users can modify this criterion for their own specific purposes 
(for any or all of the level definitions). For example, if federal or 
state policymakers need to target a program to ZIP code areas where the 
large preponderance of population was living in frontier/remote locals, 
a FAR criterion of 80 percent could be applied. The results for the 
trial application of the FAR Methodology for ZIP codes with 2000 Census 
data and Urban Area definitions for the lower 48 states and supporting 
material are available on the web. The available tables are by state, 
the four definition Levels, and in aggregate for both population and 
land area. The following FAR development project data and materials are 
available to users at the two cited web locations:
    Web location 1 (Economic Research Service): http://www.ers.usda.gov/data-products/frontier-and-remote-area-codes.aspx.
    (1) General description of the FAR taxonomy; and
    (2) Downloadable files by state and for the whole nation for 
residential ZIP code areas, and census tracks will be available (the 
files will include: Identification code; population count; Level 1, 2, 
3, and 4 designation status, frontier or not based on majority of 
population); percentage of population that meet and do not meet 
frontier criteria for each of the levels; land area designated as 
frontier/remote by each of the Levels, land area not designated as 
frontier/remote by each of the Levels, and state where the majority of 
the population resides; and
    (3) Maps.
    Web location 2 (Center for Rural Health, University of 
North Dakota):http://ruralhealth.und.edu/frontier/.
    (1) Current version of the rural, frontier, and island definition 
literature review (this review will continue to be updated as new 
material is obtained and as new definitions are created);
    (2) Detailed description of the developmental project (e.g., 
summary of regional stakeholder meetings and composition of advisory 
groups);
    (3) Description of the purposes and principles upon which the 
taxonomy was developed;
    (4) Detailed description of the analytical methods; and
    (5) Sensitivity analyses, comparisons with other designation 
methods, maps and the like.
    The aggregate results are summarized below in Table 1.

     Table 1--Aggregate FAR US 2000 Census Results for 48 Conterminous States by Definition Level Categories
----------------------------------------------------------------------------------------------------------------
                                                                                Percent of
                         Level                               Population         population     Percent land area
----------------------------------------------------------------------------------------------------------------
Level 1................................................         17,960,713                6.5               54.8
Level 2................................................         12,391,300                4.5               48.8
Level 3................................................          8,032,822                2.9               43.0
Level 4................................................          4,782,328                1.7               35.2
----------------------------------------------------------------------------------------------------------------

    The state-level results are available at the FAR section of the ERS 
Web site (see: http://www.ers.usda.gov/data-products/frontier-and-remote-area-codes.aspx). For instance, for the Level 1 FAR sub 
definition, the states in order from highest to lower for percentages 
(top 10) of frontier population are: Wyoming (61.2%), Montana (57.7%), 
North Dakota (48.6%), South Dakota (45.4%), Mississippi (39.6%), 
Nebraska (35.9%), New Mexico (32.4%), Kansas (25.4%), Vermont (24.9%), 
and Iowa (23.5%). The similar top 10 for percentage of land area are: 
Nevada (90.1%), Montana (87.5%), Nebraska (87.2%), South Dakota 
(86.8%), Wyoming (86.7%), North Dakota (86.5%), New Mexico (82.2%), 
Utah (81.8%), Kansas (76.9%), and Colorado (74.1%). The similar top 10 
by total frontier population are: Texas, Mississippi, Missouri, 
Minnesota, Kentucky, Michigan, Iowa, Kansas, Nebraska, and Illinois. 
The lists for the other Levels vary. For example, the top five 
regarding percentage of the population designated as frontier per the 
Level 4 sub definition are: North Dakota (26.2%), South Dakota (24.5%), 
Montana (15.5%), Wyoming (12.9%), and Nebraska (10.3%). Note that 
Alaska and Hawaii are not included here but will be included in the 
2010 version of the FAR codes and will undoubtedly appear on the lists.
    HRSA is now seeking public comments on:
    (1) The use of a population threshold of 50,000 as the central 
place from which to measure in defining FAR areas;
    (2) The use of 60 minutes travel time from the central place;
    (3) Whether the 50 percent population threshold for assigning 
frontier status to a ZIP code/census tract is the appropriate level for 
the four standard provided levels;
    (4) Other ways of representing urban and rural areas;
    (5) Alternatives to using grid cells for measuring remoteness;
    (6) Applicability of the FAR methodology to island populations; and
    (7) Need for a Census tract and county version of the FAR.
    Comments on other aspects of the methodology are welcomed. 
Commenters are reminded that this is only a proposed methodology, and 
it is not currently tied to any current federal program or allocation 
of resources. It is only a tool to better delineate those isolated and 
remote areas in the country to help researchers and policy makers 
better understand the unique circumstances of this geographic subset.

    Dated: October 26, 2012.
Mary K. Wakefield,
Administrator.

Bibliography

Ciarlo, J.A., J.H. Wackwitz, et al. `Focusing on ``Frontier': 
Isolated Rural America.'' Letter to the Field No. 2. Frontier Mental 
Health Services Resource Network. (1996). http://www.wiche.edu/MentalHealth/Frontier/letter2.asp
Duncan, D. Miles From Nowhere: Tales From America's Contemporary 
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