The Advanced Nursing Education (ANE) Program Specific Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 ANE Program Specific Form	Form and Instruction	Modified	Available
Change Memo - Name change to ANE.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2021-11-16	Available
ANE Supporting Statement A.docx	Supporting Statement A	Uploaded 2021-09-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
209293	ANE Program Specific Form	Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0375	ICR Reference No: 202111-0915-001
Status: Active	Previous ICR Reference No: 202109-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No: 20937
Title: The Advanced Nursing Education (ANE) Program Specific Form
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: Approved without change	Conclusion Date: 11/16/2021
	Date Received in OIRA: 11/16/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2024	11/30/2024	11/30/2024
Responses	521	0	521
Time Burden (Hours)	3,647	0	3,647
Cost Burden (Dollars)	0	0	0

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Abstract: HRSA will use this information in determining the amount of traineeship support to be awarded per student per institution, and to succinctly capture data for the number of projected students for determining eligibility for Special Consideration and Statutory Funding Preference.

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Authorizing Statute(s): US Code: 42 USC Section 811 296j(a)(2) Name of Law: Public Health Service Act
   US Code: 42 USC 296 Name of Law: Advanced Education Nursing Grants
  

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:
	86 FR 36756	07/13/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 53071	09/28/2021
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
ANE Program Specific Form	1	ANE Program Specific Data Forms.docx

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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	521	521	0	0	0	0
Annual Time Burden (Hours)	3,647	3,647	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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:

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Annual Cost to Federal Government: $0

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

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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: 11/16/2021

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