Hispanic-Serving Institutions (HSI) Certification Form

Forms and Documents

Document	Type	Status	Availability
Form NSF 1715 Hispanic-Serviing Institutions Certification Form	Form	New	Available
nsf18524.pdf	Supplementary Document	Uploaded 2018-02-15	Available
HSI Certification Supporting Statement 012518 (002).docx	Supporting Statement A	Uploaded 2018-02-09	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
230025	Hispanic-Serviing Institutions Certification Form	Form	New

ICR Details

OMB Control No: 3145-0247	ICR Reference No: 201802-3145-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: NSF	Agency Tracking No:
Title: Hispanic-Serving Institutions (HSI) Certification Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/23/2018
	Date Received in OIRA: 02/15/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2021	36 Months From Approved
Responses	175	0	0
Time Burden (Hours)	6	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The lead institution submitting a proposal to the Hispanic-Serving Institution Program must certify that they meet the eligibility requirements of an HSI as defined by law in section 502 of the Higher Education Act of 1965 (20 U.S.C. 1101a) (http://legcounsel.house.gov/Comps/HEA65_CMD.pdf). Therefore, the HSI Certification Form, signed by the institutional representative, must be included as a supplementary document with the submission of a proposal to the HSI Program.

---

Authorizing Statute(s): US Code: 42 USC 1861 et seq. Name of Law: The National Science Foundation Act of 1950, as amended
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 58454	12/12/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 6881	02/15/2018
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Hispanic-Serviing Institutions Certification Form	NSF 1715	HSI Certification Form

---

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	175	0	0	175	0	0
Annual Time Burden (Hours)	6	0	0	6	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: This is a new collection for the National Science Foundation.

---

Annual Cost to Federal Government:

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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

---

Common Form ICR:  No

---

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: 02/15/2018

---