FINAL SNC SP 2019 Nonsubstantive Change Memo OMB

DATE: December 13, 2018

TO: Quinn Hirsch, OMB Desk Officer

FROM: Lisa Wright-Solomon, HRSA Information Collection Clearance Officer

_____________________________________________________________________________

Request: The Health Resources and Services Administration’s (HRSA) Bureau of Health Workforce (BHW) requests approval for non-substantive changes to the NURSE Corps (NC) Scholarship Program (SP) Application and Program Guidance (APG) documents (OMB #, 0915-0301 expires 05/31/2021). The APG package includes the NC SP Online Application User Guide, which asks for personal, professional, and financial information needed to determine the applicant's eligibility to participate in the NC SP as a new recipient or through a continuation award. Also included are the In-Service Verification (ISV) forms which are used to determine if a participant is in compliance with their NC contract.

Purpose: The purpose of these proposed changes is to align the APG, Online Application User Guide, and the ISVs with the current Administration’s priority of combating the opioid epidemic via medication-assisted treatment, substance use disorder services, telehealth, as well as a tax change.

Time Sensitivity: Updates to the BHW Management Information Systems Solution (BMISS) are essential prior to the beginning of any application period (for both the new and continuation NC SP application cycles) by February 28, 2019 so that these changes can be made to BMISS in time for the application cycle).

Applicants submit their NC SP applications within the Customer Service Portal that houses the application during critical periods of the year for both continuations and new applicants. Designed to be compatible with the narrative and data requirements that are outlined in the APG, the inclusion of these additional questions are contingent upon the approval of the non-substantive changes outlined in this memo. Given the upcoming release date of March 14, 2019 , delayed updates related to the Customer Service Portal will inhibit the collection of pertinent data that will help HRSA measure key indicators associated with both substance abuse disorder service and telehealth activities.

HRSA uses the In-Service Verification form to monitor participants’ number of absences from their service site to determine if participants are in compliance with program rules.

Burden: It is anticipated that the changes included herein will have minimal impact on the burden of the NC SP application process or the ISVs. No new HRSA forms will be required and the additional questions will be inserted into the larger, already-approved NC SP application and ISV forms.

PROPOSED CHANGES FOR THE NC SP NEW AND CONTINUATION APG AND APPLICATION USER GUIDE DOCUMENTS:

Adding two new questions to the New NC SP APG and nine new questions to the Continuation NC SP APG to be more in line with Administration priorities, as well as the evolving health care landscape. (See questions below)

Questions include the following:

Questions for FY19 NC SP New Award Application

Federal Pipeline Questions:

1. Federal pipeline programs are designed to enhance educational opportunities and increase the number of students from disadvantaged backgrounds to progress from elementary through post-undergraduate levels. These programs offer an array of academic enrichment activities and services to better prepare disadvantaged students to successfully graduate from a health professions school. Please select any federal pipeline programs that you have participated in at any point in your educational journey (select all that apply). By selecting a Pipeline Program in the NCSP application, you will be required to submit official documentation of your successful completion of any ONE of the federal pipeline programs you selected.

U.S. Department of Education (ED)

• Federal TRIO Programs

• Promising Neighborhoods Program

• Student Support Services

• Educational Opportunity Centers

• Talent Search

• Upward Bound

• Upward Bound Math-Science

• Veterans Upward Bound

• Gaining Early Awareness and Readiness for Undergraduate Programs (GEAR UP)

HHS/Health Resources and Services Administration (HRSA)

• Centers of Excellence (COE) Program

• Health Careers Opportunity Program (HCOP)

• Area Health Education Centers Program (AHEC)

• Health Profession Opportunity Grant (HPOG)

• National Workforce Diversity Pipeline Program (NWDP)

• Scholarships for Disadvantaged Students (SDS)

HHS/National Institutes of Health (NIH)

• Community Health Worker Health Disparities Initiative

National Science Foundation

• Tribal Colleges and Universities Program (TCUP)

• Alliance for Graduate Education and the Professoriate (AGEP)

• Historically Black Colleges and Universities - Undergraduate Program (HBCU-UP)

Other Federal Pipeline Programs (the application will provide an opportunity to submit the name of any federal pipeline program not identified above).

Tax Questions:

2. Applicants selected for a NCSP award will now be required to fill out a W4 form for IRS tax purposes

1. Filing status (Box 3 on Form W-4)*

2. Last name differs from that shown on your social security card (Box 4 on Form W-4)

3. Total number of Allowances (Box 5 on Form W-4)*

4. Additional withholding amount (if any) (Box 6 on Form W-4)

5. Claim exemption (Box 7 on Form W-4)

Questions for FY19 NC SP Continuation Application:

Mental Questions:

1. Are you a licensed Psychiatric Nurse Practitioner?

   1. If yes, please upload your credentials in the Supporting Documents section

   2. no

2. Do you have another Behavioral Health training or certification?

   1. If yes, please upload your credentials in the Supporting Documents section

   2. No

3. Will you have substance use disorder training or certification by September 30, 2019?

   1. Yes

   2. No

Telehealth Questions:

4. Do you or will you personally provide some form of telehealth in your clinical practice? (With “Tool Tip” which is currently on new award for FY 2018.)

1. Yes

2. No

3. I don’t know

5. When providing telehealth:

1. I am the clinician at the originating site whose patient is receiving the consult/care

2. I am the clinician at the distant site providing the consult/care

3. I don’t know

4. Other

6. What percentage of your clinical practice is/will be spent providing telehealth services?

1. <10%

2. 10-24%

3. 25-49%

4. 50%>

5. I don’t know

Multiple Site Questions:

7. Do you currently work at multiple sites?”

1. Yes

2. No

8. If yes, are you working at the same employer at all Critical Shortage Facility types?

3. Yes

4. No

Tax Questions:

9. Applicants selected for a NCSP award will now be required to fill out a W4 form for IRS tax purposes

6. Filing status (Box 3 on Form W-4)*

7. Last name differs from that shown on your social security card (Box 4 on Form W-4)

8. Total number of Allowances (Box 5 on Form W-4)*

9. Additional withholding amount (if any) (Box 6 on Form W-4)

10. Claim exemption (Box 7 on Form W-4)

PROPOSED CHANGES FOR THE NC SP IN-SERVICE VERIFICATION DOCUMENTS:

Adding a total of 6 new questions to be more in line with Administration priorities as well as the evolving health care landscape. (See questions below)

Questions include:

1. Do you or will you personally provide some form of telehealth in your clinical practice?

1. Yes

2. No

3. I don’t know

2. When providing telehealth:

1. I am the clinician at the originating site whose patient is receiving the consult/care

2. I am the clinician at the distant site providing the consult/care

3. I don’t know

4. Other

3. What telehealth technologies did you use? (Select all that apply)

1. Real-time telehealth (e.g., video conference)

2. Store-and-forward telehealth (e.g., secure email with photos or videos of patient examinations)

3. Remote patient monitoring

4. Mobile Health (mHealth)

4. What percentage of your clinical practice is/will be spent providing telehealth services?

1. <10%

2. 10-24%

3. 25-49%

4. 50%>

5. I don’t know

5. Do you currently work at multiple sites?

   1. Yes

   2. No

6. If yes, are you working at the same employer at all Critical Shortage Facility types?

   1. Yes

   2. No

Attachments:

1. NC SP Online Application User Guide

   1. Federal Pipeline Question Screenshot

   2. W-4 Tax Screenshot

2. NC SP In-Service Verification Guide

   1. In-Service Verification Screenshot

   2. Employment Verification Screenshot

Requested Changes to NCSP Application and Online Application User Guide (OMB #0915-0301, expires 05/31/2021), Page 8