Health Resources and Services Administration
The National Health Service Corps and NURSE Corps Interest Capture Form
OMB Control No. 0915-0337
Supporting Statement A
A. Justification
Circumstances Making the Collection of Information Necessary
This is an information collection request for the extension, with no changes, of the National Health Service Corps (NHSC) and NURSE Corps Programs’ Interest Capture From (OMB No.: 0915-0337, Expiration Date: 4/30/2017). The Interest Capture Form is used by potential applicants of the Health Resources and Services Administration’s (HRSA) Bureau of Health Workforce’s (BHW) NHSC and NURSE Corps programs. The legislative authorities for the NHSC program are Sections 331 and 338A-H of the Public Health Service (PHS) Act (Attachments A and B). The legislative authority for the NURSE Corps Program is Section 846 of the PHS Act (Attachment C).
Under the NHSC and NURSE Corps programs, the Department of Health and Human Services (HHS) enters into contracts with selected primary care health professionals who agree to provide primary health services at approved facilities in designated health professional shortage areas (HPSAs) or serve as nurse faculty employed by an accredited school of nursing. In return for these services, HHS agrees to provide financial support through scholarships or loan repayment which goes towards the health professionals' qualifying educational loans and/or educational costs.
The NHSC and NURSE Corps programs are both 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. In order to recruit new applicants to the Programs and to fulfill increasing recruitment goals, BHW is actively marketing the NHSC and NURSE Corps programs to currently practicing clinicians as well as students in health professions training programs.
Purpose and Use of Information Collection
The NHSC and NURSE Corps Programs Interest Capture Form (Attachment D), which BHW uses when exhibiting at national and regional conferences as well as when presenting on campuses to health profession students, is an optional form that a health professions student, licensed clinician, faculty member, or clinical site administrator can fill out and submit to BHW representatives at the recruitment event. The purpose of the form is to enable individuals and clinical sites to ask BHW for periodic program updates and other general information regarding opportunities with the NHSC and/or the NURSE Corps programs via e-mail. Completed forms contain information such as the names of the individuals, their email address(es), their city and state, the organization where they are employed (or the school which they attend), the year they intend to graduate (if applicable), how they heard about the NHSC/NURSE Corps, and the programs in which they are interested. Assistance in completing the form is given by the BHW staff person (or BHW representative) who is present at the event. The information collected is kept on file for approximately three years in order to account for any expired information and to maintain up-to-date records.
Use of Improved Information Technology and Burden Reduction
This information collection is a paper-based form.
Efforts to Identify Duplication and Use of Similar Information
The information requested in the Interest Capture Form is specific to the applicant and unique to the NHSC and NURSE Corps programs.
Impact on Small Businesses or Other Small Entities
The information collection will not have a significant impact on small entities.
Consequences of Collecting the Information Less Frequently
The information collected in the Interest Capture Form is used to enable individuals and clinical sites to ask BHW for periodic program updates and other general information regarding opportunities with the NHSC and/or the NURSE Corps via e-mail. The follow-up process for NHSC and NURSE Corps applicants is necessary to keep a potential applicant pool informed of the benefits of the NHSC and NURSE Corps and their potential membership into these programs. If BHW did not collect information from these individuals who were met (by BHW representatives) at marketing and recruitment events, the programs would be missing an opportunity to reach out, engage, and obtain future applicants.
There are no legal obstacles to reduce the burden.
Special Circumstances Relating to the Guidelines of 5 CFR 1320.5
The request fully complies with the regulation.
Comments in Response to the Federal Register Notice/Outside Consultation
Section 8A
A 60-day Federal Register Notice was published in the Federal Register on February 21, 2017, vol. 82, No. 33; pp. 11231-11232 (https://www.gpo.gov/fdsys/pkg/FR-2017-02-21/pdf/2017-03335.pdf). There were no public comments.
Section 8B
To get an estimate of the burden collection for the approximate time (in hours) that it will take an individual to complete the Interest Capture Form, HRSA staff consulted the following individuals to witness the time it took (an average of 90 seconds) for a respondent to complete the form.
Zuleika Bouzeid
Bureau of Health Workforce
Health Resources and Services Administration
5600 Fishers Lane
Rockville, MD 20857
(301) 443-0603
Tayri Ramos
Bureau of Health Workforce
Health Resources and Services Administration
5600 Fishers Lane
Rockville, MD 20857
(301) 443-9057
Nicole Walker-Hollis
Bureau of Health Workforce
Health Resources and Services Administration
5600 Fishers Lane
Rockville, MD 20857
(301) 443-0677
Explanation of any Payment/Gift to Respondents
Respondents will not receive any payment or gifts.
Assurance of Confidentiality Provided to Respondents
Data will be kept private to the extent allowed by law. The Programs Interest Capture Form does not collect any PII data.
Justification for Sensitive Questions
There are no questions of a sensitive nature.
Estimates of Annualized Hour and Cost Burden
The estimated burden for this collection is 60 hours. This burden did not change from the previously approved information clearance request. Additionally, the expected respondents are also the same and include individuals interested in the NHSC or NURSE Corps programs such as health professions students, clinicians, faculty at accredited health professions schools, and clinical site administrators.
Section 12A - Estimated Annualized Burden Hours
Burden Estimate:
Type of Respondent |
Form Name |
No. of Respondents |
No. Responses per Respondent |
Total Responses |
Average Burden per Response (in hours) |
Total Burden Hours |
Interested Applicant |
NHSC and NURSE Corps Programs Interest Capture Form |
2,400 |
1 |
2,400 |
0.025 |
60 |
Total |
|
2,400 |
-- |
2,400 |
-- |
60 |
Burden estimates were originally derived from information based on an exhibit and presentation schedule. Based on the schedule, the NHSC was estimated to gather information from 2,400 individuals. Using this as a guide for future years, the estimated annual burden is as shown above as a total of 60 hours. It is estimated that it will take an average of 90 seconds to complete the Interest Capture Form. (2,400 interested applicants x (1 response x 1.5/60 hours/response per form) = 60 total burden hours).
Section 12B
Estimated Annualized Burden Costs
Type of Respondent |
Total Burden Hours |
Hourly Wage Rate |
Total Respondent Costs |
Interested Applicant (e.g., Health Professions Students, Clinicians, Faculty) |
60 |
$0.00 |
$0.00 |
Total |
|
|
$0.00 |
Since the students and professionals who are completing these forms are doing so while attending conferences or special campus presentations and not during work hours in which they receive a salary, the hourly wage rate is $0.00.
Estimates of other Total Annual Cost Burden to Respondents or Recordkeepers/Capital Costs
Other than their time, there is no cost to respondents.
Annualized Cost to Federal Government
The average annual costs to the government for collecting the NHSC and NURSE Corps Programs Interest Capture Form is as follows:
Instrument |
GS-Level/Base Pay Rate |
Project Time per FTE |
Number of FTEs |
Total |
NHSC and NURSE Corps Programs Interest Capture Form Data Entry |
$36,281.00 |
.15 |
1 |
$5,442.15 |
Total |
|
|
|
$5,442.15 |
The data entry of collected forms is minimal. One FTE at the GS-5, step 1 level, who spends 15% of their time inputting the contact information, has an annual salary of $36,281.00. It is estimated that the annualized total cost to the government is $5,442.15.
Explanation for Program Changes or Adjustments
This are no program changes or adjustments and there are no changes to the burden.
Plans for Tabulation, Publication, and Project Time Schedule
There are no plans for tabulation, statistical analysis, or publication of data requested.
Reason(s) Display of OMB Expiration Date is Inappropriate
The OMB number and expiration date will be displayed on every page of every form/instrument.
Exceptions to Certification for Paperwork Reduction Act Submissions
There are no exceptions to the certification.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Supporting Statement - NHSC-NC Int Capt Form_Final |
| Author | kthomas |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |