NHSC Recruitment and Retention Assistance Application

ICR 200202-0915-003

OMB: 0915-0230

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
6467
Migrated
ICR Details
0915-0230 200202-0915-003
Historical Active 199810-0915-001
HHS/HSA
NHSC Recruitment and Retention Assistance Application
Revision of a currently approved collection   No
Regular
Approved with change 04/19/2002
Retrieve Notice of Action (NOA) 02/21/2002
Approved with change to the race/ethnicity category noted in memo dated 4/18/02. The "other" category will be removed, and more than one race can be selected for each entry.
  Inventory as of this Action Requested Previously Approved
06/30/2005 06/30/2005 04/30/2002
1,200 0 1,000
300 0 750
0 0 0

The Application is used in determining the eligibility of Federally approved clinical practice sites to employ NHSC health professional and to verify current needs to assign NHSC health professionals.

None
None


No

1
IC Title Form No. Form Name
NHSC Recruitment and Retention Assistance Application

  Total Approved 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 1,200 1,000 0 200 0 0
Annual Time Burden (Hours) 300 750 0 -450 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
02/21/2002


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