NHSC Recruitment and Retention Assistance Application

ICR 200507-0915-004

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
6469
Migrated
ICR Details
0915-0230 200507-0915-004
Historical Active 200504-0915-003
HHS/HSA
NHSC Recruitment and Retention Assistance Application
Revision of a currently approved collection   No
Regular
Approved without change 08/31/2005
Retrieve Notice of Action (NOA) 07/12/2005
Approved consistent with clarification in HRSA memo submitted to OMB 08/30/05.
  Inventory as of this Action Requested Previously Approved
08/31/2008 08/31/2008 08/31/2005
2,900 0 1,200
1,450 0 300
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 2,900 1,200 0 0 1,700 0
Annual Time Burden (Hours) 1,450 300 0 0 1,150 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$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.
07/12/2005


© 2024 OMB.report | Privacy Policy