Chiropractic and Pharmacy Loan Repayment Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Survey of Chiro Do Chiropractic and Pharmacy Loan Repayment- Survey of Chiropractic Doctors and Pharmacists	Form	New	Repair queued
Form Survey of Clinic M Chiropractic and Pharmacy Loan Repayment- Survey of Clinic Medical Directors	Form	New	Repair queued
Form Clinic User Survey Chiropractic and Pharmacy Loan Repayment Program- Survey of Clinic Users	Form and Instruction	New	Repair queued
Part B ss chiro july 19.doc	Supporting Statement B	Uploaded 2006-08-02	Repair queued
Part A ss chiro July19.doc	Supporting Statement A	Uploaded 2006-08-02	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
45194	Chiropractic and Pharmacy Loan Repayment- Survey of Chiropractic Doctors and Pharmacists	Form	New
45193	Chiropractic and Pharmacy Loan Repayment- Survey of Clinic Medical Directors	Form	New
45192	Chiropractic and Pharmacy Loan Repayment Program- Survey of Clinic Users	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 200609-0915-001
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Chiropractic and Pharmacy Loan Repayment Program
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 01/05/2007
	Date Received in OIRA: 09/13/2006
Terms of Clearance: This ICR has been withdrawn, per HRSA's request.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		18 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: In 2002, Congress established a demonstration project for participation of chiropractic doctors and pharmacists in the National Health Service Corps (NHSC)loan repayment program. The demonstration began in September 2003 when chirpractic doctors and pharmacists started serving two-year obligations. HRSA is submitting a request for approval to conduct three surveys that are an integral part of an evaluation of the demonstration to include chiropractic doctors and pharmacists in the NHSC loan repayment program.

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Authorizing Statute(s): PL: Pub.L. 107 - 251 317 Name of Law: Health Care Safety Net Ammendments of 2002
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	70 FR 56171	09/26/2005
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 48931	08/22/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Chiropractic and Pharmacy Loan Repayment Program- Survey of Clinic Users	Clinic User Survey- Chiro, Clinic User Survey- Pharmacist	Clinic User Survey- Pharmacist ,   Clinic User Survey- Chiro
Chiropractic and Pharmacy Loan Repayment- Survey of Clinic Medical Directors	Survey of Clinic Medical Directors- Pharm, Survey of Clinic Medical Directors - Chiro	Survey of Clinic Medical Directors- Pharm ,   Survey of Clinic Medical Directors- Chiro
Chiropractic and Pharmacy Loan Repayment- Survey of Chiropractic Doctors and Pharmacists	Survey of Chiro Doctors, Survey of Pharmacists	Survey of Chiro Doctors ,   Survey of Pharmacists

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in buden has occurred due to Public Law 107-251 stating that the HHS Secretary will evaluate the participation of individuals in the demonstration projects.

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Annual Cost to Federal Government: $494

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 08/08/2006

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