Supporting Statement

Supporting Statement for the National Health Service Corps
Ambassador Portal
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 an information collection application and database for the Health Resources and Services Administration’s (HRSA) Bureau of Clinician Recruitment and Service’s National Health Service Corps (NHSC) Ambassador Program. The current NHSC program 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.

The National Health Service Corps is 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. The NHSC programs provide scholarships and repay educational loans for primary care physicians, dentists, nurse practitioners, physician assistants, behavioral health providers, and other primary care providers who agree to practice in areas of the country that need them most.

The NHSC invites individuals who are affiliated with academic, clinical, trade and other public health related organizations to apply to be volunteers within the NHSC Ambassador Program.

NHSC Ambassadors are dedicated volunteers who help educate and inform prospective NHSC members. Ambassadors give their time and talents to spread the word about the opportunities available through the NHSC and serve as additional local resources for current NHSC members. NHSC Ambassadors inspire and motivate students and providers to provide primary health care in communities with limited access to care.

The NHSC Ambassador Portal will serve as both the application interface for interested individuals to apply and become NHSC Ambassadors, as well the public-facing online searchable database of Ambassador contact information. Applicants will create individual Ambassador profiles that will contain information such as name, email address(es), professional/employment information (including organization name and address, (or the school which they attend), phone number(s), which discipline of students and/or professionals they interact with, and a brief reason why they would like to be an Ambassador. Completed applications will be forwarded through the Portal to NHSC staff for approval. If approved, the NHSC Ambassador will have the opportunity to add a brief professional biography and social network addresses to their profile. Assistance in completing the application will be provided through prompts via the online portal and also through the NHSC Customer Care Center, if necessary.

2. Purpose and Use of Information

The purpose of the NHSC Ambassador Portal is to create a database where interested parties can search for NHSC Ambassadors (that meet specific search criteria) to serve as local resources on the NHSC programs. The NHSC Ambassador Portal also serves as a system to capture and track Ambassador data and relevant information as needed by the NHSC, including providing access to volunteers who are available to spread important programmatic information on behalf of the NHSC.

3. Use of Improved Information Technology

The NHSC Ambassador Portal is fully web-based. The application and database can be accessed through the NHSC web site at https://programportal.hrsa.gov/extranet/ambassador/login.seam.

4. Efforts to Avoid Duplication

The information requested through the NHSC Ambassador Portal is specific to the applicant and unique to the NHSC.

5. Involvement of Small Entities

This information collection will not have a significant impact on small entities.

6. Consequences if Information is Collected Less Frequently

If the information collected through the NHSC Ambassador Portal was collected less frequently, the NHSC would not have up-to-date, accurate contact data for our Ambassadors preventing the Ambassador Program from functioning effectively to provide essential technical assistance to current NHSC members and potential scholarship and loan repayment 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 March 12, 2014, Vol.79, No. 48, page 14056-14057. No comments were received.

The NHSC surveyed current NHSC Ambassadors in order to obtain constructive feedback to improve the application and database, improve efficiency, and minimize the collection burden. There were no suggestions for changes or revisions. The individuals contacted are listed below.

Regina J. Knox, MPH, CHES

Executive Director, West Central Alabama AHEC

800 Hall Street

Greensboro, AL 36744

Rashad A. Collins

Director of Workforce Development

Community Health Center Association of CT

100 Great Meadow Road, Suite 400

Wethersfield, CT 06109

Cindy Ellis

Recruitment & Retention Coordinator

National Health Service Corps Liaison

Texas Primary Care Office

PO Box 149347, Mail Code 1937

Austin, TX 78756

Thomas Shaffer

Trained Health Insurance Market Place Navigator

5689 Robinhood Dr.

Portage, MI 49024

Wendy Biss
NHSC Member

18608 SE 20^th Circle

Vancouver, WA 98683

9. Remuneration of Respondents

Respondents will receive no remuneration.

10. Assurance of Confidentiality

Data collected through the NHSC Ambassador Portal is stored in the BCRS Management Information System Solution (BMISS) database which serves as a system of record as defined under the Privacy Act of 1974.

11. Questions of a Sensitive Nature

There is no data of sensitive nature collected through the NHSC Ambassador Portal.

12. Estimates of Annualized Hour Burden

The estimates of reporting burden are as follows:

Form Name	Number of Respondents	Number of Responses per Respondent	Total Responses	Average Burden per Response (in hours)	Total Burden Hours	Hour Cost	Total Hour Cost
Ambassador Portal – New Applicants	200	1	200	.10	20	$53	$1,060
Ambassador Portal – Updates to current Ambassador profiles	500	1	500	.10	50	$53	$2,650
Total	700		700		70		$3,710

Basis for estimates:

In FY 2012 and FY 2013, an average of 120 individuals signed up to be new NHSC Ambassadors. With new promotion efforts underway, the number of new Ambassadors is estimated to increase to approximately 200 annually. Also, current Ambassadors will be prompted to update their contact information in the Portal on an annual basis. It is estimated that of the nearly 1,000 Ambassadors, 50% will comply (approximately 500 respondents). As a result, it is estimated that the total annual burden for this collection will be 70 hours (20 hours for new applications and 50 hours for profile updates). It is estimated that the hour cost per individual (e.g. clinicians, school or site administrators, faculty members and/or members of professional health organizations) completing the application or profile would be an average of $53 per hour ($60/hour + $48 + $52 = $160/3 = $53). The wage rates for individuals (as listed above) were based on mean hourly wages and salary information obtained through the Bureau of Labor Statistics (http://www.bls.gov/oes/current/oes_nat.htm#29-0000). The total hour cost associated with the NHSC Ambassador Portal activity would be $3,710.

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

Instrument	Base Pay Rate	Project Time per FTE	Number of FTEs	Total Annual Cost
NHSC Ambassador Portal (new applications and updated profiles)	$67,297/GS-11, Step 3	.10	2	$13,459

The NHSC Ambassador Portal activity is conducted internally, by BCRS’ Division of External Affairs (DEA). The estimated, annualized cost to the Government for the NHSC Ambassador Portal activity is approximately $13,459. This total accounts for two FTEs at a GS-11, Step 3 level, who both spend roughly 10% of their work time reviewing, processing and/or updating applications and Ambassador Portal profile information.

15. Changes in Burden

There are no changes to the burden, as this is a new information collection request. There is no previous OMB clearance inventory or burden hours recorded for this activity.

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).

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