Teacher Verification Form for Title II Scholarship Recipients

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
TQE Scholarship Contractal Agreement	Form and Instruction	Removed	Available
TQE Scholarship Terms and Conditions Addendum	Form and Instruction	Removed	Available
Verification of Teacher Obligation	Form	Modified	Available
TQE Scholarship Form Addendum	Form and Instruction	Removed	Available
TQE Scholarship Contractal Agreement	Form and Instruction	Removed	Available
TQE Verification of Teaching Obligation	Form and Instruction	Removed	Available
1840-0753 2016 Supporting Statement Part A clean (3).docx	Supporting Statement A	Uploaded 2017-03-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43987	Teacher Quality Enhancement Grants -- Burden to IHEs	Form and Instruction	Removed	TQE Scholarship Contractal Agreement
43987	Teacher Quality Enhancement Grants -- Burden to IHEs	Form and Instruction	Removed	TQE Scholarship Terms and Conditions Addendum
184029	Teacher Verification Form for Title II Scholarship Recipients	Form	Modified	Verification of Teacher Obligation
184028	Teacher Quality Enhancement Grants -- Scholarship Receipents	Form and Instruction	Removed	TQE Scholarship Form Addendum
184028	Teacher Quality Enhancement Grants -- Scholarship Receipents	Form and Instruction	Removed	TQE Scholarship Contractal Agreement
184028	Teacher Quality Enhancement Grants -- Scholarship Receipents	Form and Instruction	Removed	TQE Verification of Teaching Obligation

ICR Details

OMB Control No: 1840-0753	ICR Reference No: 201612-1840-002
Status: Historical Active	Previous ICR Reference No: 201403-1840-006
Agency/Subagency: ED/OPE	Agency Tracking No:
Title: Teacher Verification Form for Title II Scholarship Recipients
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: 06/12/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/09/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2020	36 Months From Approved	06/30/2017
Responses	1,000	0	410
Time Burden (Hours)	1,000	0	350
Cost Burden (Dollars)	0	0	0

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Abstract: In order to implement the requirements of the statute, confidential information on scholarship recipients will be collected. Specifically, the institution of higher education (IHE) will report to ED the name, address, social security number, and date of birth for each recipient at the time a scholarship award is made. These data will be used to track students after the completion of their studies (or withdrawal from the program) to ascertain whether they are fulfilling the teaching requirement of their award. Any data that is required and maintained by ED itself will be maintained in accordance with the Privacy Act of 1974, as amended. To assure that sensitive data about scholarship recipients are not compromised, all data—whether submitted electronically or as hard copy—will be maintained in a secure location. Access to these data will be limited only to staff who are directly responsible for working with the Teacher Quality Enhancement (TQE) Program and this information is only available onsite at the TQE office via desktop computer. As noted in the Privacy Act of 1974 (5 U.S.C. 552a), the authority for collecting the requested information from and about TQE scholarship recipients is Title II, Section 204(e) of the Higher Education Act of 1965, as amended, and 31 U.S.C. Chapter 37. IHE students are advised that participation in the Teacher Quality Enhancement Grants scholarship program is voluntary and that giving the Department their Social Security Numbers (SSNs) is voluntary, but they must provide the requested information, including their SSNs, to participate. The information will be used to ensure that recipients of scholarships provided with funds under Title II of the Higher Education Act subsequently: (1) complete a teacher education program and teach in a high-need school of a high-need local educational agency for a period of time equivalent to the period for which the recipient received scholarship assistance; or (2) repay the amount of the scholarship. The information in students’ records may be disclosed to third parties as authorized under routine uses in the appropriate systems of records, either on a case-by-case basis, or, if the Department has complied with the computer matching requirements of the Privacy Act, under a computer matching agreement.

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Authorizing Statute(s): PL: Pub.L. 105 - 244 204(e) Name of Law: The Higher Education Act of 1965, as amended
  

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 90797	12/15/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 13104	03/09/2017
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
Teacher Quality Enhancement Grants -- Burden to IHEs	N/A, N/A	TQE Scholarship Terms and Conditions Addendum ,   TQE Scholarship Contractal Agreement
Teacher Quality Enhancement Grants -- Scholarship Receipents	N/A, N/A, N/A	TQE Verification of Teaching Obligation ,   TQE Scholarship Contractal Agreement ,   TQE Scholarship Form Addendum
Teacher Verification Form for Title II Scholarship Recipients	N/A	Verification of Teacher Obligation

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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	1,000	410	0	590	0	0
Annual Time Burden (Hours)	1,000	350	0	650	0	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: There is a change in burden because ED is no longer collecting the TQE Scholarship Contractual Agreement or the TQE Scholarship Terms and Conditions Addendum that were previously provided in the clearance package. They are only contacting recipients who do not have a Verification of Teaching Obligation Form on file showing that they completed the requirements. Burden estimates have been updated to reflect this change in the use of forms as well as the anticipated number of scholarship recipients who will need to complete and submit the Verification Form.

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Annual Cost to Federal Government: $129,839

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: 03/09/2017

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