Reference Request for Applicants to the U.S. Public Health Service Commissioned Corps

Forms and Documents

Document Name	Status
OMB No 0937-0025 Final PHS 50 and PHS 1813_Sept_9_16.docx Supporting Statement A	2016-09-09

IC Document Collections

IC ID	Document Title	Status
7733	PHS-50	Modified
46578	PHS-1813	Modified
223158	Addendum: Commissioned Corps Personal Statement Other-application	New
193548	Interested Health Professionals	Modified

ICR Details

OMB Control No: 0937-0025	ICR Reference No: 201607-0937-001
Status: Historical Active	Previous ICR Reference No: 201310-0937-002
Agency/Subagency: HHS/OASH	Agency Tracking No:
Title: Reference Request for Applicants to the U.S. Public Health Service Commissioned Corps
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/07/2016
	Date Received in OIRA: 09/12/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2019	36 Months From Approved	12/31/2016
Responses	12,000	0	14,900
Time Burden (Hours)	4,250	0	4,900
Cost Burden (Dollars)	12,000	0	30,000

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Abstract: The forms will be used by individuals to apply for appointment in the U.S. Public Health Service Commissioned Corps and to obtain references as part of the application process. Information supplied on the forms will be used by appropriate Department officials to evaluate candidates for appointment.

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Authorizing Statute(s): US Code: 37 USC 101 Name of Law: (3)
  

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:
	81 FR 37198	06/09/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 57595	08/23/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
PHS-50
PHS-1813
Interested Health Professionals
Addendum: Commissioned Corps Personal Statement

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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	12,000	14,900	0	-2,900	0	0
Annual Time Burden (Hours)	4,250	4,900	0	-650	0	0
Annual Cost Burden (Dollars)	12,000	30,000	0	-18,000	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: This is an extension request and there are no changes to how candidates receive the application forms.

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Annual Cost to Federal Government: $221,160

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? Yes

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: 09/12/2016

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