Retention Survey of NHSC Clinicians and Alumni/NHSC Site Administrators

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 6 Survey of NHSC Recent Alumni (Scholars)	Form	New	Available
Form 5 Survey of NHSC Recent Alumni (LRP)	Form	New	Available
Form 4 Survey of NHSC Alumni (LRP)	Form	New	Available
Form 3 Survey of NHSC Clinicians in Service (Scholars)	Form	New	Available
Form 2 Survey of NHSC Clinicians in Service (LPR)	Form	New	Available
Form 1 Survey of 2010 Site Administrators	Form	New	Available
THE SUPPORTING STATEMENT- Revised 6-21-2011 Section B.doc	Supporting Statement B	Uploaded 2011-07-19	Available
THE SUPPORTING STATEMENT- Revised 6-21-2011 Section A.doc	Supporting Statement A	Uploaded 2011-07-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
197239	Survey of NHSC Recent Alumni (Scholars)	Form	New	Survey of NHSC Recent Alumni (Scholars)
197238	Survey of NHSC Recent Alumni (LRP)	Form	New	Survey of NHSC Recent Alumni (LRP)
197237	Survey of NHSC Alumni (LRP)	Form	New	Survey of NHSC Alumni (LRP)
197236	Survey of NHSC Clinicians in Service (Scholars)	Form	New	Survey of NHSC Clinicians in Service (Scholars)
197235	Survey of NHSC Clinicians in Service (LRP)	Form	New	Survey of NHSC Clinicians in Service (LPR)
197234	Survey of Site Administrator	Form	New	Survey of 2010 Site Administrators

ICR Details

OMB Control No: 0915-0341	ICR Reference No: 201104-0915-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Retention Survey of NHSC Clinicians and Alumni/NHSC Site Administrators
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: 07/26/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/12/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2014	36 Months From Approved
Responses	7,464	0	0
Time Burden (Hours)	1,162	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The National Health Service Corps (NHSC) Loan Repayment and Scholarship Programs were established to assure an adequate supply of trained primary care health care professionals to provide services in the neediest Health Professional Shortage Areas (HPSAs) of the United States. The last survey conducted to analyze retention of NHSC clinicians was over a decade ago. This new survey will reevaluate the personal/professional development of NHSC clinicians in an effort to retain the clinicians in service providing care for individuals residing in underserved areas.

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Authorizing Statute(s): US Code: 42 USC 254d 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:
	75 FR 238	12/13/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 41	03/02/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Survey of NHSC Alumni (LRP)	4	Survey of NHSC Alumni (LRP)
Survey of NHSC Clinicians in Service (LRP)	2	Survey of NHSC Clinicians in Service (LPR)
Survey of NHSC Clinicians in Service (Scholars)	3	Survey of NHSC Clinicians in Service (Scholars)
Survey of NHSC Recent Alumni (LRP)	5	Survey of NHSC Recent Alumni (LRP)
Survey of NHSC Recent Alumni (Scholars)	6	Survey of NHSC Recent Alumni (Scholars)
Survey of Site Administrator	1	Survey of 2010 Site Administrators

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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	7,464	0	0	7,464	0	0
Annual Time Burden (Hours)	1,162	0	0	1,162	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: This is a new Information Collection Activity initiated by the Bureau of Clinician Recruitment and Service.

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Annual Cost to Federal Government: $315,803

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 04/12/2011

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