The Nursing Scholarship Program

Forms and Documents

Document Name	Status
Form 1 Eligible Applications/Application Program Guidance Form	Modified
Form 10 Authorization to Release Information Form Form	New
Form 9 CSF Verification Form Form	New
Form 8 Verification of Academic Standing Form	New
Form 7 In Service Verification Form Form	New
Form 6 Initial Employment Verification Form Form	New
Form 5 Graduation Close Out Form Form	New
Form 4 Data Collection Worksheet Form Form	New
Form 3 Confirmation of Interest Form Form	New
Form 2 School Enrollment Verification Form Form	New
NC SP - Supporting Statement - Final.docx Supporting Statement A	2020-03-05

IC Document Collections

IC ID	Document Title	Status
43610	Eligible Applications/Application Program Guidance Form	Modified
240484	Authorization to Release Information Form Form	New
240483	CSF Verification Form Form	New
240481	Verification of Academic Standing Form	New
240480	In Service Verification Form Form	New
240478	Initial Employment Verification Form Form	New
240475	Graduation Close Out Form Form	New
240473	Data Collection Worksheet Form Form	New
240471	Confirmation of Interest Form Form	New
240469	School Enrollment Verification Form Form	New

ICR Details

OMB Control No: 0915-0301	ICR Reference No: 202003-0915-001
Status: Active	Previous ICR Reference No: 201804-0915-003
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: The Nursing Scholarship Program
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: 04/14/2020
	Date Received in OIRA: 03/10/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2023	36 Months From Approved	05/31/2021
Responses	8,950	0	8,250
Time Burden (Hours)	7,139	0	6,934
Cost Burden (Dollars)	0	0	0

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Abstract: The NCSP collects information to determine an applicant’s eligibility for the program, monitor a participant’s continued enrollment in a school of nursing, monitor the participant’s compliance with the NCSP service obligation, and prepare annual reports to Congress.

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Authorizing Statute(s): US Code: 42 USC 297n(a), section 846(d) 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:
	84 FR 53158	10/04/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 13664	03/09/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 10

IC Title	Form No.	Form Name
CSF Verification Form	9	CSF Verification Form.pdf
Authorization to Release Information Form	10	Authorization To Release Information Form
Eligible Applications/Application Program Guidance	1	Eligible Applications/Application Program Guidance
School Enrollment Verification Form	2	School Enrollment Verification Form
Confirmation of Interest Form	3	Confirmation of Interest Form
Data Collection Worksheet Form	4	Data Collection Worksheet Form
Graduation Close Out Form	5	Close Out Graduation Form
Initial Employment Verification Form	6	Initial Employment Verification Form
In Service Verification Form	7	In-Service Verification Form
Verification of Academic Standing	8	Verification of Academic Standing

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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	8,950	8,250	0	700	0	0
Annual Time Burden (Hours)	7,139	6,934	0	205	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: Yes

Burden Reduction Due to: Using Information Technology

Short Statement: The increase in burden is due to additional application questions about telehealth services, multiple CSF sites, salary, and occupational specializations. Enhancements in BMISS has decreased burden time, allowing electronic submission of participants’ banking information for stipend payments which previously had to be uploaded.

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Annual Cost to Federal Government: $2,190,543

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

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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: 03/10/2020

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