NURSE Corps Loan Repayment Program

ICR 201804-0915-004

OMB: 0915-0140

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Form and Instruction
Removed
Form and Instruction
Modified
Supporting Statement A
2018-04-23
ICR Details
0915-0140 201804-0915-004
Historical Active 201704-0915-005
HHS/HSA 21547
NURSE Corps Loan Repayment Program
Revision of a currently approved collection   No
Regular
Approved without change 05/17/2018
Retrieve Notice of Action (NOA) 04/25/2018
  Inventory as of this Action Requested Previously Approved
05/31/2021 36 Months From Approved 06/30/2020
21,900 0 15,600
25,505 0 13,850
0 0 0

The need and purpose of this information collection is to obtain information for NURSE Corps LRP applicants and participants. The information is used to consider an applicant for a NURSE Corps LRP contract award, and to monitor a participant’s compliance with the service requirements. Individuals must submit an application in order to participate in the program. The application asks for personal, professional, educational, and financial information required to determine the applicant's eligibility to participate in the NURSE Corps LRP. The semi-annual employment verification form asks for personal and employment information to determine if a participant is in compliance with the service requirements. Respondents include professional RNs or advanced practice RNs (i.e., nurse practitioners, certified registered nurse anesthetists, certified nurse-midwives, clinical nurse specialists) who are interested in participating in the NURSE Corps LRP, and official representatives at their service sites.

PL: Pub.L. 107 - 205 0 Name of Law: PHSA Nurse Recruitment
   PL: Pub.L. 111 - 148 0 Name of Law: PPACA
   US Code: 42 USC 297n Section 846(a) Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  82 FR 56040 11/27/2017
83 FR 15162 04/09/2018
No

  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 21,900 15,600 0 6,300 0 0
Annual Time Burden (Hours) 25,505 13,850 0 11,655 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Changing Forms
An increase in forms added burden while a changing of forms also reduced burden. Data collected on the individual NURSE Corps LRP application and monitoring forms constitutes a system of records under the Privacy Act of 1974. The applicable Privacy Act system is the “Public Health Service and National Health Service Corps Health Care Provider Records System” (09-15-0037).

$1,046,529
No
    Yes
    Yes
Yes
No
No
Uncollected
Elyana Bowman 301 443-3983 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
04/25/2018


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