The Nursing Scholarship Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form B The Nursing Scholarship Program	Form and Instruction	Unchanged	Available
W4 Screenshots.docx	Supplementary Document	Uploaded 2018-12-13	Available
NCSP Employment Verification Form.docx	Supplementary Document	Uploaded 2018-12-13	Available
In Service Verification Telehealth Question Screenshot.jpg	Supplementary Document	Uploaded 2018-12-13	Available
FY19 NCSP Application Federal Pipeline Question Screenshot.pdf	Supplementary Document	Uploaded 2018-12-13	Available
FINAL SNC SP 2019 Nonsubstantive Change Memo OMB.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2018-12-13	Available
NURSE Corps SP Supporting Statement.doc	Supporting Statement A	Uploaded 2018-04-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43610	The Nursing Scholarship Program	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0915-0301	ICR Reference No: 201812-0915-002
Status: Historical Inactive	Previous ICR Reference No: 201804-0915-003
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: The Nursing Scholarship Program
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 12/21/2018
	Date Received in OIRA: 12/18/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2021	05/31/2021	05/31/2021
Responses	8,250	0	8,250
Time Burden (Hours)	6,934	0	6,934
Cost Burden (Dollars)	0	0	0

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Abstract: The Nurse Corps Scholarship Program needs to collect data to determine an applicant’s eligibility for the program, to monitor a participant’s continued enrollment in a school of nursing, to monitor the participant’s compliance with the Nurse Corps Scholarship Program service obligation, and to obtain data on its program to ensure compliance with statutory mandates and prepare annual reports to Congress. Respondents include Nurse Corps Scholarship Program scholar participants, graduates, and school administrators.

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Authorizing Statute(s): US Code: 42 USC 297n, section 846(h) 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:
	82 FR 56618	11/29/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 13136	03/27/2018
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
The Nursing Scholarship Program	J, C, E, F, H, B, D, I, G	Attachment B-Eligible Application screenshots .pdf ,   Attachment C-NCSP APG.docx ,   Attachment D-Graduation Close Out Form.docx ,   Attachment E - Confirmation of Interest Form Screenshots.pdf ,   Attachment F-Contract.pdf ,   Attachment G - Data Collection Worksheet Screenshot.pdf ,   Attachment H - School Enrollment Verification Form.pdf ,   Attachment I-Initial Employment Verification Form.pdf ,   Attachment J - Employer-Participant Service Verification Screenshots.pdf

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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: No

Burden Reduction Due to:

Short Statement: An increase in respondents resulted to an increase in burden.

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Annual Cost to Federal Government: $91,721

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.     Yes

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.     Yes

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

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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: 12/18/2018

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