Supporting Statement_NHSC and NURSE Corps Int Cap Form_final_01292014

Supporting Statement for National Health Service Corps & Nurse Corps

Interest Capture Form
Health Resources and Services Administration

A. JUSTIFICATION

1. Circumstances of Information Collection

This is a request for Office of Management and Budget (OMB) approval of a data collection form for potential applicants of the Health Resources and Services Administration’s (HRSA) Bureau of Clinician Recruitment and Service’s National Health Service Corps (NHSC) and NURSE Corps programs. The current NHSC and NURSE Corps regulations are as follows:
42 CFR Part 62 (Public Health Service Act Section 338A(42 USC 254l), Sections 338C-H(42 USC 254m-q), Section 338B(42 USC 254l-1),and Section 331(i)(42 USC 254d(i)),as amended); and 42 USC 297(n)(d) (Public Health Service Act Section 846(d),as amended).

Under the NHSC and Nurse Corps, the Department of Health and Human Services (HHS) enters into contracts with selected primary care health professionals who agree to provide primary health services at approved facilities in designated health professional shortage areas (HPSAs) or serve as nurse faculty employed by an accredited school of nursing. In return for these services, HHS agrees to provide financial support through scholarships or loan repayment which goes towards the health professionals' qualifying educational loans and/or educational costs.

The NHSC and NURSE Corps are both committed to improving the health of the Nation’s underserved by uniting communities in need with caring health professionals and by supporting communities’ efforts to build better systems of care. In order to recruit new applicants to the Programs and to fulfill increasing recruitment goals, BCRS is actively marketing the NHSC and NURSE Corps Programs to currently practicing clinicians as well as students in health profession training programs.

2. Purpose and Use of Information

The NHSC and Nurse Corps Interest Capture Form, which BCRS will use when exhibiting at national and regional conferences as well as when presenting on campuses to health profession students, is an optional form that a health profession student, licensed clinician, faculty member, or clinical site administrator can fill out and submit to BCRS representatives at the recruitment event. The purpose of the form is to enable individuals and clinical sites to ask BCRS for periodic program updates and other general information regarding opportunities with the NHSC and/or the NURSE Corps via e-mail. Completed forms will contain information such as the names of the individuals, their email address(es), their city and state, the organization where they are employed (or the school which they attend), the year they intend to graduate (if applicable), how they heard about the NHSC/NURSE Corps, and the programs in which they are interested. Assistance in completing the form will be given by the BCRS staff person (or BCRS representative) who is present at the event. The information collected will be kept on file for approximately 3 years in order to account for any expired information and to maintain up-to-date records.

3. Use of Improved Information Technology

The NHSC/NURSE Corps Interest Capture Form is a paper-based form.

4. Efforts to Avoid Duplication

The information requested in the Interest Capture Form is specific to the applicant and unique to the NHSC and NURSE Corps.

5. Involvement of Small Entities

The forms will not have a significant impact on small entities.

6. Consequences if Information is Collected Less Frequently

The follow-up process for NHSC and NURSE Corps applicants is necessary to keep a potential applicant pool that is kept informed of the benefits of the NHSC and NURSE Corps and their potential membership into these Programs. If BCRS did not collect information from these individuals who were met (by BCRS representatives) at marketing and recruitment events, the Programs would be missing an opportunity to reach out, engage, and obtain future applicants.

7. Consistency with the Guidelines in 5 CFR 1320.5 (d)(2)

This information collection is consistent with 5 CFR 1320.5 (d)(2).

8. Consultation Outside the Agency

The notice required in 5 CFR 1320.8(d) was published in the Federal Register on November 20, 2013, Vol.78, No. 224, page 69694. The form was completed on-site at the recruitment events from 2010 to 2013. NHSC representatives witnessed the time it took (an average of 90 seconds) for the respondent to complete the form.

9. Remuneration of Respondents

Respondents will receive no remuneration.

10. Assurance of Confidentiality

As no Personal Identification Information will be collected on this form, there is no need for an Assurance of Confidentiality.

11. Questions of a Sensitive Nature

There is no data of sensitive nature collected on this form.

12. Estimates of Annualized Hour Burden

The estimates of reporting burden are as follows:

Form	Number of Respondents	Responses per Respondent	Total Responses	Hours per Response	Total Burden Hours	Hour Cost	Total Hour Cost
NHSC and NURSE Corps Interest Capture Form	2400	1	2400	.025 (90 seconds)	60	0	0
Total	2400	1	2400	.025 (90 seconds)	60	0	0

Basis for estimates:

Based on the FY13 exhibit and presentation schedule, NHSC could have gathered information from 2,400 individuals. Using this as a guide for future years, the estimated annual burden is as shown above as a total of 60 hours. Total hour cost is $0. This is based on the fact that the students and professionals who are completing these forms are doing so while attending conferences or special campus presentations and not during work hours in which they receive a salary.

13. Estimates of Annualized Cost Burden to Respondents

There are no capital or start-up costs to respondents. There are no operation or maintenance costs to lenders; all information is maintained for usual business purposes.

14. Estimates of Annualized Cost to the Government

The data entry of collected forms is minimal. One FTE at the GS-5, step 1 level, who spends 15% of her time inputting the contact information, has an annual salary of $34,415. 15% of $34,415= $5,162 and is our estimated annualized cost to the Government.

15. Changes in Burden

There are no changes to the burden.

16. Time Schedule, Publication and Analysis Plans

There are no plans for tabulation, statistical analysis, or publication of data requested.

17. Exemption for Display of Expiration Date

No exemption is requested.

18. Certifications

This project fully complies with the requirements in 5 CFR 1320.5(d)(2).