Scholarships for Disadvantaged Students Application Program Specific Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Scholarships for Disadvantaged Students (SDS) Program Application Form	Form and Instruction	Modified	Available
Form 2 Scholarships for Disadvantaged Students Performance Report Form	Form and Instruction	New	Available
Supporting Statment.doc	Supporting Statement A	Uploaded 2013-11-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6377	Scholarships for Disadvantaged Students (SDS) Program Application Form	Form and Instruction	Modified
209465	Scholarships for Disadvantaged Students Performance Report Form	Form and Instruction	New

ICR Details

OMB Control No: 0915-0149	ICR Reference No: 201311-0915-004
Status: Historical Active	Previous ICR Reference No: 201011-0915-001
Agency/Subagency: HHS/HSA	Agency Tracking No: 20517
Title: Scholarships for Disadvantaged Students Application Program Specific Form
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/27/2014
	Date Received in OIRA: 11/22/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2017	36 Months From Approved	01/31/2014
Responses	598	0	600
Time Burden (Hours)	9,952	0	8,400
Cost Burden (Dollars)	0	0	0

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Abstract: The Scholarships for Disadvantaged Students (SDS) Program provides scholarship funds to schools for distribution to undergraduate and graduate students from disadvantage backgrounds who are preparing for the health professions.

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Authorizing Statute(s): US Code: 42 USC 293a Name of Law: Public Health Service Act
   PL: Pub.L. 111 - 148 7101 Name of Law: Affordable care Act of 2010
   PL: Pub.L. 105 - 392 737 Name of Law: Scholarships for Disadvantaged Students
  

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:
	78 FR 41405	07/10/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 66944	11/07/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Scholarships for Disadvantaged Students (SDS) Program Application Form	1, 1a	SDS App ,   SDS App Instructions
Scholarships for Disadvantaged Students Performance Report Form	2b, 2	SDSPR ,   SDSPR guidance

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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	598	600	0	-200	198	0
Annual Time Burden (Hours)	9,952	8,400	0	-824	2,376	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: In FY 2012, the SDS program changed from a 1 year formula grant to a 4 year project competitive grant which lowers the number of eligible grantees. In the last clearance package we estimated 500 applications and 500 reports to be submitted. The old SDS formula program allowed all eligible applicants to receive funds and all eligible applicants were required to submit an annual performance report. The numbers decreased from 500 applications to 400 applications since there were 400 applicants in FY 2012, but only 99 applicants were funded. Therefore, only 99 awardees will be required to submit a SDS performance report. In addition, the SDS performance report will be required twice a year instead of annually.

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Annual Cost to Federal Government: $104,600

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]? Yes

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: 11/22/2013

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