NHSC Recruitment and Retention Assistance Application

Forms and Documents

Document	Type	Status	Availability
NHSC Site Application Summary of Minor Additions.doc	Supplementary Document	Uploaded 2011-10-24	Available
OMB_NHSC_Site_Application_SupportingStmt_08.09.2011_final.doc	Supporting Statement A	Uploaded 2011-08-09	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
6469	NHSC Recruitment and Retention Assistance Application	Instruction	Modified

ICR Details

OMB Control No: 0915-0230	ICR Reference No: 201108-0915-001
Status: Historical Active	Previous ICR Reference No: 200807-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: NHSC Recruitment and Retention Assistance Application
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/31/2011
	Date Received in OIRA: 08/12/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2014	36 Months From Approved	10/31/2011
Responses	3,000	0	2,900
Time Burden (Hours)	1,500	0	1,450
Cost Burden (Dollars)	0	0	0

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Abstract: The National Health Service Corps (NHSC) Recruitment and Retention Assistance Site Application is used for determining the eligibility of federally approved clinical practice sites to employ NHSC health professionals, and to verify current site needs to assign NHSC health professionals.

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Authorizing Statute(s): US Code: 42 USC 254f Name of Law: Priorities in assignment of Corps personnel
   US Code: 42 USC 254d Name of Law: National Health Service Corps
   US Code: 42 USC 254f1 Name of Law: Provision of services by Corps members
  

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:
	76 FR 33768	06/09/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 48171	08/08/2011
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
NHSC Recruitment and Retention Assistance Application	1	NHSC Site Application

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ICR Summary 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	3,000	2,900	0	100	0	0
Annual Time Burden (Hours)	1,500	1,450	0	50	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: There are changes to the estimate of burden. Specifically, the total hour burden has increased from 1450 to 1500 due to the increase in the number of respondents. The current burden for this activity in the OMB inventory of approved collections is for 3,000 respondents with 1,500 total burden hours.

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Annual Cost to Federal Government: $37,436

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]? 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: 08/12/2011

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