Reference Request for Applicants to the U.S. Public Health Service Commissioned Corps

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0937-0025 - TAB E.pdf	Supplementary Document	Uploaded 2006-12-21	Available
0937-0025TAB B-D.pdf	Supplementary Document	Uploaded 2006-12-21	Available
SupportingStatement-0937-0025.doc	Supporting Statement A	Uploaded 2006-12-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7733	PHS-50		Modified
46578	PHS-1813		New

ICR Details

OMB Control No: 0937-0025	ICR Reference No: 200612-0937-001
Status: Historical Active	Previous ICR Reference No: 200307-0937-001
Agency/Subagency: HHS/OASH	Agency Tracking No:
Title: Reference Request for Applicants to the U.S. Public Health Service Commissioned Corps
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/16/2007
	Date Received in OIRA: 12/28/2006
Terms of Clearance: Approved consistent with the following terms of clearance: HHS shall continue to ensure that electronic forms display the current OMB control number, date of expiration and burden statement. Additionally, prior to the next submission of this collection to OMB for review HHS should assess the feasibility of providing respondents with electronic signature technology consistent with GPEA.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2010	36 Months From Approved	02/28/2007
Responses	5,000	0	10,000
Time Burden (Hours)	2,000	0	4,000
Cost Burden (Dollars)	2,000	0	0

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Abstract: The forms will be used by individuals to apply for appointment in the U.S. Public Health Service Commissioned Corps and to obtain references as part of the application process. Information supplied on the forms will be used by appropriate Department officials to evaluate candidates for appointment.

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Authorizing Statute(s): US Code: 37 USC 101 Name of Law: (3)
  

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:
	71 FR 57511	09/29/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 71168	12/08/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
PHS-1813
PHS-50

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ICR Summary of Burden

table that charts list of burden

	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	5,000	10,000	0	-5,000	0	0
Annual Time Burden (Hours)	2,000	4,000	0	-2,000	0	0
Annual Cost Burden (Dollars)	2,000	0	0	2,000	0	0

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: Yes

Burden Reduction Due to: Using Information Technology

Short Statement: The Corps Web site contains a Prequalification Questionnaire and potential applicants can find out immediately if they are qualified to apply to the Corps simply by answering a few questions. Thus, those potential applicants who are found not qualified, avoid an unnecessary burden of completing the application packet.

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Annual Cost to Federal Government: $150,300

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

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: 12/28/2006

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