Bureau of Health Workforce (BHW) Substance Use Disorder (SUD) Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form B2 Bureau of Health Workforce Substance Use Disorder Evaluation	Form and Instruction	New	Available
Attachment A - 60 day FRN.pdf	Supplementary Document	Uploaded 2020-05-01	Available
Attachment C14 - Grantee Follow-up Phone Script_FINAL 04.08.20.docx	Supplementary Document	Uploaded 2020-04-29	Available
Attachment C13 - SMS Reminder_FINAL 04.08.20.docx	Supplementary Document	Uploaded 2020-04-29	Available
Attachment C12 - Reminder Letter - All Surveys_FINAL 04.08.20.docx	Supplementary Document	Uploaded 2020-04-29	Available
Attachment C11 - Reminder Email to Grantees about Contact Information_FINAL 04.08.20.docx	Supplementary Document	Uploaded 2020-04-29	Available
Attachment C10 - Survey Advertisement Text_FINAL 04.08.20.docx	Supplementary Document	Uploaded 2020-04-29	Available
Attachment C9 - Reminder Email from HRSA to NHSC Participants and Sites_FINAL 04.08.20.docx	Supplementary Document	Uploaded 2020-04-29	Available
Attachment C8 - Reminder Email from HRSA to Grantees_FINAL 04.08.20.docx	Supplementary Document	Uploaded 2020-04-29	Available
Attachment C7 - Reminder Email from Grantees_FINAL 04.08.20.docx	Supplementary Document	Uploaded 2020-04-29	Available
Attachment C6 - Reminder Email - All Surveys_FINAL 04.08.20.docx	Supplementary Document	Uploaded 2020-04-29	Available
Attachment C5 - Introductory Email Template_All Surveys_FINAL 04.08.20.docx	Supplementary Document	Uploaded 2020-04-29	Available
Attachment C4 - Contact Information Request Template_FINAL 04.08.20.xlsx	Supplementary Document	Uploaded 2020-04-29	Available
Attachment C3 - Introductory Email from Grantees_FINAL 04.08.20.docx	Supplementary Document	Uploaded 2020-04-29	Available
Attachment C2 - Contact Information Request Email_FINAL 04.08.20.docx	Supplementary Document	Uploaded 2020-04-29	Available
Attachment C1 - Advance Introduction to Grantees_FINAL 04.08.20.docx	Supplementary Document	Uploaded 2020-04-29	Available
BHW SUD Supporting Statement B -- NORC response CLEAN.docx	Supporting Statement B	Uploaded 2020-06-30	Available
BHW SUD Supporting Statement A --NORC_response CLEAN.docx	Supporting Statement A	Uploaded 2020-06-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
241617	Bureau of Health Workforce Substance Use Disorder Evaluation	Form and Instruction	New

ICR Details

OMB Control No: 0906-0054	ICR Reference No: 202004-0906-002
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Bureau of Health Workforce (BHW) Substance Use Disorder (SUD) Evaluation
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: 07/07/2020
	Date Received in OIRA: 05/04/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2023	36 Months From Approved
Responses	41,300	0	0
Time Burden (Hours)	13,289	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The Bureau of Health Workforce is conducting a national evaluation of investments in the expansion of National Health Service Corps Loan Repayment Program sites and clinicians, and three educational and training grant programs including the grantees, grantee training sites and trainees. The surveys capture information that is not available through any administrative sources and are necessary to assess program impact and inform future strategic direction of program efforts.

---

Authorizing Statute(s): US Code: 42 USC 254H Name of Law: National Health Service Corps Program
  

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:
	85 FR 4327	01/24/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 25453	05/01/2020
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Bureau of Health Workforce Substance Use Disorder Evaluation	B1, B2, B5, B6, B3, B4	Attachment B2 - NHSC LRP Site Survey_FINAL 04.08.20.docx ,   Attachment B1 - NHSC LRP Participant Survey_FINAL 04.08.20.docx ,   Attachment B5 - Grantee Site Survey_FINAL 04.08.20.docx ,   Attachment B6 - Grantee Organization Survey_FINAL 04.08.20.docx ,   Attachment B3 - Grantee Trainee Survey -- NORC response CLEAN.docx ,   Attachment B4 - Grantee Alumni Survey -- NORC response.docx

---

ICR Summary of Burden

table that charts list 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	41,300	0	0	41,300	0	0
Annual Time Burden (Hours)	13,289	0	0	13,289	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 ICR, so burden is increasing from zero (0).

---

Annual Cost to Federal Government: $51,000

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? No

---

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: 05/04/2020

---