Advanced Education Nursing Traineeship (AENT) Program Specific Data Collection Forms for Use with the New Advanced Nursing Education Workforce (ANEW) Program

Forms and Documents

Document Name	Status
Form 1 AENT Program Forms Form and Instruction	Modified
OMB ANEW Program Specific Data Tables Renewal Package_tracked changes.docx Supplementary Document	2017-01-12
OMB ANEW Program Specific Data Tables Renewal Package_clean copy.docx Supplementary Document	2017-01-12
ANEW Supporting Statement Revised format.docx Supporting Statement A	2017-01-12

IC Document Collections

IC ID	Document Title	Status
209293	AENT Program Forms Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0375	ICR Reference No: 201701-0915-005
Status: Historical Active	Previous ICR Reference No: 201311-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No: 20937
Title: Advanced Education Nursing Traineeship (AENT) Program Specific Data Collection Forms for Use with the New Advanced Nursing Education Workforce (ANEW) Program
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: 05/15/2017
	Date Received in OIRA: 01/13/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2020	36 Months From Approved	05/31/2017
Responses	236	0	70
Time Burden (Hours)	1,652	0	882
Cost Burden (Dollars)	0	0	0

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Abstract: This data collection is essential in serving as an instrument for determining award amounts. Not collecting this vital data would impact the agency’s ability to (1) institute the ANEW Program, (2) provide program specific information, and (3) determine award amounts. Likely respondents are schools of nursing, nursing centers, academic health centers, State or local governments and other private or public nonprofit entities.

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Authorizing Statute(s): US Code: 42 USC Section 811 296j(a)(2) 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 78608	11/08/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 2383	01/09/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
AENT Program Forms	2 , 1	ANEW Table 1 ,   ANEW Table 2

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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	236	70	0	166	0	0
Annual Time Burden (Hours)	1,652	882	0	770	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: No

Burden Reduction Due to:

Short Statement: Increase due to an increase in anticipated responses.

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Annual Cost to Federal Government: $0

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]? Yes

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: 01/13/2017

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