Cover Memo 2010

National Health Service Corps Loan Repayment Program - OMB No. 0915-0127

DATE: August 27, 2010

FROM: Reports Clearance Officer, HRSA

TO: Office of Information and Regulatory Affairs, OMB

Through: Reports Clearance Officer, DHHS

SUBJECT: Health Resources and Services Administration – National Health Service Corps Loan Repayment Program - OMB No. 0915-0127

This is a request for extension of a current OMB approval for the Health Resources and Services Administration’s National Health Service Corps Loan Repayment Program (NHSC LRP) Forms, with OMB No. 0915-0127 expiring in 10/31/2010. These application forms provide information to HRSA for consideration of an applicant for a NHSC LRP contract award.

There is an error in calculation of burden hours in the 30 day Federal Register Notice (FRN) that published on August 23, 2010 for these application forms. In the attached Supporting Statement, we have corrected the error that was found after publication of the 30 day FRN:

• The Payment Information Form was erroneously included in the estimation of annual burden hours. This form is currently approved by OMB under OMB Control No. 1510-0007 and can be found at http://www.fms.treas.gov/eft/1199a.pdf and its inclusion in this submission was duplicative.

The correction is highlighted in the below table:

Form	Number of Respondents	Responses per Respondent	Total Responses	Hours per Respondent	Total Hour Burden	Hour Cost	Total Hour Cost
LRP Application Form	5,175	1*	5,175	.3	1,553	$20	$31,060
Payment Information Form	5,175	1	5,175	.20	1,035	$20	$20,700
Employment and Verification and Community Site Information Form	5175	1	5,175	.75	3,881	$20	$77,620
Loan Information and Verification Form	5,175	3	15,525	.3	4,658	$20	$93,160
Authorization to Release Information	5,175	1	5,175	.1	518	$20	$10,360
NHCS Alumni Database	5,000	1	5,000	.20	1,000	$20	$20,000
Self-Certification Form	5,175	1	5,175	.1	518	$20	$10,360
Total			41,2256,400		121283,163		$263,260242560

The current total burden hours in the OMB inventory for the National Health Service Corps Loan Repayment Program (OMB No. 0915-0127) is 12,128 hours. The renewal that is being submitted includes an increase in total annual burden hours from the currently approved 8030 hours to 12,128 hours due to program change, of which 11,128 is due to statute and 1,000 of which is due to OPDIV discretion.

Nidhi Singh

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