The Nursing Scholarship Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3b In-Service BCRS Verification Form	Form and Instruction	Modified	Available
Form 3a In-Service Monitoring Initial Verification of Employment	Form and Instruction	Modified	Available
Form 2b In-School Monitoring - School Verification form	Form and Instruction	Modified	Available
Form 1c Application contract	Form	Modified	Available
Form 2a In-school Monitoring DCW form	Form and Instruction	Modified	Available
Form 1b Application Program Guidance	Form and Instruction	Modified	Available
Form 1a application screenshots	Form and Instruction	Modified	Available
Attachment A - Nursing Legislation.pdf	Supplementary Document	Uploaded 2012-06-21	Available
Supporting Statement HRSA.doc	Supporting Statement A	Uploaded 2012-08-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43610	The Nursing Scholarship Program	Form and Instruction	Modified	In-Service BCRS Verification Form
43610	The Nursing Scholarship Program	Form and Instruction	Modified	In-Service Monitoring Initial Verification of Employment
43610	The Nursing Scholarship Program	Form and Instruction	Modified	In-School Monitoring - School Verification form
43610	The Nursing Scholarship Program	Form	Modified	Application contract
43610	The Nursing Scholarship Program	Form and Instruction	Modified	In-school Monitoring DCW form
43610	The Nursing Scholarship Program	Form and Instruction	Modified	Application Program Guidance
43610	The Nursing Scholarship Program	Form and Instruction	Modified	application screenshots

ICR Details

OMB Control No: 0915-0301	ICR Reference No: 201206-0915-004
Status: Historical Active	Previous ICR Reference No: 200907-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: The Nursing Scholarship Program
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: 08/31/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/22/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2015	36 Months From Approved	09/30/2012
Responses	5,700	0	5,100
Time Burden (Hours)	10,200	0	10,200
Cost Burden (Dollars)	0	0	0

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Abstract: The Nursing Scholarship Program's purpose is to provide scholarships to nursing students in exchange for a service commitment at an eligible health facility with a critical shortage of nurses. Under this program, students seeking to become registered nurses are offered the opportunity to enter into a contractural agreement under which HHS agrees to pay the total school tuition required fees, and a stipend for living expenses.

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Authorizing Statute(s): US Code: 42 USC 846 Name of Law: Public Health Service Act
  

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:
	77 FR 20645	04/05/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 34390	06/11/2012
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
The Nursing Scholarship Program	1a, 1b, 2a, 1c, 2b, 3a, 3b	application screenshots ,   Application Program Guidance ,   In-school Monitoring DCW form ,   Application contract ,   In-School Monitoring - School Verification form ,   In-Service Monitoring Initial Verification of Employment ,   In-Service BCRS Verification Form

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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	5,700	5,100	0	600	0	0
Annual Time Burden (Hours)	10,200	10,200	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $625,100

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: 06/22/2012

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