Nurse Faculty Loan Program (NFLP) Program Specific Data Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Blank NFLP Application Data Form 0378.docx	Form and Instruction	Modified	Available
FW Comments for Information Collection Request Title Nurse Faculty Loan ProgramRevised Program Specific Data Form OMB No. 09150378Revision. .msg	Public Comments	Uploaded 2017-04-23	Repair queued
CommmentsSupporting Statement_NFLP_0378_Final_BHW Response 5-3-17.doc	Supporting Statement A	Uploaded 2017-05-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
210369	Nurse Faculty Loan Program (NFLP) Program Specific Data Form	Form and Instruction	Modified	Blank NFLP Application Data Form 0378.docx

ICR Details

OMB Control No: 0915-0378	ICR Reference No: 201704-0915-003
Status: Historical Active	Previous ICR Reference No: 201402-0915-004
Agency/Subagency: HHS/HSA	Agency Tracking No: 21278
Title: Nurse Faculty Loan Program (NFLP) Program Specific Data Form
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: 07/19/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/26/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2020	36 Months From Approved	07/31/2017
Responses	90	0	150
Time Burden (Hours)	720	0	1,200
Cost Burden (Dollars)	0	0	0

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Abstract: The NFLP Program Specific Data Form is included as an electronic attachment with the required application materials. The data provided in the form are essential for the formula-based criteria used to determine the award amount to the applicant schools. Approval of the revised NFLP Program Specific Data Form will facilitate our current effort to address the specific program goal of capturing data to efficiently generate the formula-based award. The electronic data collection capability will streamline the application submission process, enable an efficient award determination process and serve as a data repository to facilitate reporting on the use of funds and analysis of program outcomes.

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Authorizing Statute(s): US Code: 42 USC 297n-1, Section 846A Name of Law: Title VIII, Public Health Service Act
   PL: Pub.L. 111 - 148 5311 Name of Law: Patient Protection and Affordable care 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:
	82 FR 11229	02/21/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 19067	04/25/2017
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
Nurse Faculty Loan Program (NFLP) Program Specific Data Form	1	Blank NFLP Application Data Form 0378.docx

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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	90	150	0	-60	0	0
Annual Time Burden (Hours)	720	1,200	0	-480	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The decrease in burden is because of a decrease in the total number of respondents, from 150 to 90.

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Annual Cost to Federal Government: $3,168

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: 04/26/2017

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