Chiropractic and Pharmacy Loan Repayment Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Survey of Pharmaci Survey of Pharmacists	Form	New	Available
Form Survey of Chiro Do Survey of Chiro Doctors	Form	New	Available
Form Survey of Clinic M Survey of Clinic Medical Directors- Chiro	Form	New	Available
Form Survey of Clinic M Survey of Clinic Medical Directors- Pharm	Form	New	Available
Form Clinic User Survey Clinic User Survey- Chiro	Form and Instruction	New	Available
Form Clinic User Survey Clinic User Survey- Pharmacist	Form and Instruction	New	Available
Chiro response 3-29-07.pdf	Supplementary Document	Uploaded 2007-04-02	Available
chiro response march2007 (2).pdf	Supplementary Document	Uploaded 2007-04-02	Available
chiro response 3.doc	Supplementary Document	Uploaded 2007-04-02	Available
Part B ss chiro july 19.doc	Supporting Statement B	Uploaded 2007-01-09	Available
Part A ss chiro July19.doc	Supporting Statement A	Uploaded 2007-01-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
178407	Chiropractic and Pharmacy Loan Repayment- Survey of Chiropractic Doctors and Pharmacists	Form	New	Survey of Pharmacists
178407	Chiropractic and Pharmacy Loan Repayment- Survey of Chiropractic Doctors and Pharmacists	Form	New	Survey of Chiro Doctors
178406	Chiropractic and Pharmacy Loan Repayment- Survey of Clinic Medical Directors	Form	New	Survey of Clinic Medical Directors- Chiro
178406	Chiropractic and Pharmacy Loan Repayment- Survey of Clinic Medical Directors	Form	New	Survey of Clinic Medical Directors- Pharm
178405	Chiropractic and Pharmacy Loan Repayment Program- Survey of Clinic Users	Form and Instruction	New	Clinic User Survey- Chiro
178405	Chiropractic and Pharmacy Loan Repayment Program- Survey of Clinic Users	Form and Instruction	New	Clinic User Survey- Pharmacist

ICR Details

OMB Control No: 0915-0306	ICR Reference No: 200701-0915-004
Status: Historical Active	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: Approved with change	Conclusion Date: 04/03/2007
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/22/2007
Terms of Clearance: This ICR is approved on the understanding that HRSA will 1) inform respondents that their responses will be kept private to the extent permitted by law; 2) will have a mechanism in place to minimize duplicate responses for the clinic user survey; 3) because of the small number of demonstration sites, HRSA will integrate several different analyses whenever possible and build a body of evidence to answer each research question; and 4) administrative data maintained by community health centers and clinics will be used to adjust for non-response.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2009	18 Months From Approved
Responses	2,090	0	0
Time Burden (Hours)	545	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- Pharmacist, Clinic User Survey- Chiro	Clinic User Survey- Pharmacist ,   Clinic User Survey- 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
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

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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	2,090	0	0	2,090	0	0
Annual Time Burden (Hours)	545	0	0	545	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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: 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: 01/08/2007

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