Application for Participation in the National Health Service Corps Scholarship Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Application for Participation in the National Health Service Corps Scholarship Program	Form	Modified	Available
0146 response.doc	Supplementary Document	Uploaded 2008-01-04	Available
0146 cfr.wpd	Supplementary Document	Uploaded 2008-01-02	Available
0146 nhsc nac members.doc	Supplementary Document	Uploaded 2008-01-02	Repair queued
0146 nhsc Advisory Council.doc	Supplementary Document	Uploaded 2007-12-21	Available
ss 0146 12_2007.doc	Supporting Statement A	Uploaded 2008-01-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6375	Application for Participation in the National Health Service Corps Scholarship Program	Form	Modified

ICR Details

OMB Control No: 0915-0146	ICR Reference No: 200801-0915-002
Status: Historical Active	Previous ICR Reference No: 200307-0915-005
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Application for Participation in the National Health Service Corps Scholarship Program
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/22/2008
	Date Received in OIRA: 01/08/2008
Terms of Clearance: Clarification: this ICR does not represent a PRA violation. Though it expired, HRSA did not use it to collect any information until it was reinstated. HRSA used that time to revise the application for greater utility, and the application has been much improved as a result. As experience with this new application grows, HRSA shall continue to monitor the extent to which it can predict retention.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2011	36 Months From Approved
Responses	1,800	0	0
Time Burden (Hours)	5,400	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The National Health Service Corps (NHSC) Scholarship Program offers scholarship awards to health professions students in return for the provision of full-time clinical services in a federally designated Health Professional Shortage Area. The NHSC Scholarship application collects information to select applicants for scholarship awards. The application information is necessary in order to determine those applicants that meet award criteria specified by Federal statute and regulation.

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Authorizing Statute(s): PL: Pub.L. 107 - 251 1533 Name of Law: Health Care Safety Net Amendments of 2002
   US Code: 42 USC 254 Name of Law: National Health Service Corps
  

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:
	72 FR 43283	08/03/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 871	01/04/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Application for Participation in the National Health Service Corps Scholarship Program	1	1

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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	1,800	0	0	-1,300	0	3,100
Annual Time Burden (Hours)	5,400	0	0	2,300	0	3,100
Annual Cost Burden (Dollars)	0	0	0	-8,000	0	8,000

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: Cutting Redundancy

Short Statement: After many years of use without change, the NHSC Scholarship Application has been reviewed and revised to provide more useful information for the application and selection process for awards. The progam has discontinued the interview portion of this information collection and has removed sections of the application that asked personal questions with limited utility. This program change has resulted in an increase in the burden on respondents in order to obtain information that will have substantially greater practical utility.

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Annual Cost to Federal Government: $53,225

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? 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: 01/07/2008

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