Grant Reviewer Recruitment Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 DIR Grant Reviewer Recruitment Form	Form and Instruction	Modified	Available
2016 Supporting_Statement 13MAY16.doc	Supporting Statement A	Uploaded 2016-12-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6550	DIR Grant Reviewer Recruitment Form	Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0295	ICR Reference No: 201612-0915-001
Status: Historical Active	Previous ICR Reference No: 201411-0915-005
Agency/Subagency: HHS/HSA	Agency Tracking No: 20871
Title: Grant Reviewer Recruitment Form
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: 03/09/2017
	Date Received in OIRA: 12/06/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2020	36 Months From Approved	03/31/2017
Responses	5,250	0	5,250
Time Burden (Hours)	1,707	0	1,707
Cost Burden (Dollars)	0	0	0

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Abstract: The Health Resources and Services Administration (HRSA), Office of Financial Assistance Management (OFAM), Division of Independent Review (DIR) is tasked with conducting peer reviews of grant applications for competitive grant programs. DIR is requesting an extension of OMB’s approval to continue using the Grant Reviewer Recruitment Form. This utilized an easy use format with a searchable function to find and solicit qualified reviewers using key words provided by the competing Program.

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Authorizing Statute(s): US Code: 42 USC 799(f) and 806(c) 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:
	81 FR 66665	09/28/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 86722	12/01/2016
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
DIR Grant Reviewer Recruitment Form	1	RRM Screen Shots

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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	5,250	5,250	0	0	0	0
Annual Time Burden (Hours)	1,707	1,707	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: $4,391

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: 12/06/2016

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