Bureau of Health Workforce (BHW) Program Specific Form

Forms and Documents

Document Name	Status
Form 2 Scholarships for Disadvantaged Students Program Specific Data Forms Form	New
Form 1 Program Specific Form Form	New
BHW Program Specific Form - Supporting Statement A.docx Supporting Statement A	2022-09-29

IC Document Collections

IC ID	Document Title	Status
256154	Scholarships for Disadvantaged Students Program Specific Data Forms Form	New
256153	Program Specific Form Form	New

ICR Details

OMB Control No:	ICR Reference No: 202209-0906-002
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Bureau of Health Workforce (BHW) Program Specific Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/29/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	2,392	0
Time Burden (Hours)	38,979	0
Cost Burden (Dollars)	0	0

---

Abstract: This data will expand the capacity of BHW to fund grantees to increase the representation and retention of under-represented minorities and disadvantaged individuals in education and training pathways as well as the health care workforce. In programs, where statutorily supported and in cases where the prevalence of health conditions disproportionately affects underserved communities, this data will be included as a part of the objective review criterion. Collecting these data in the scientific database will help grant reviewers, policy makers and HRSA staff make decisions that advance the health equity mission of the Department. The respondents include eligible applicants for BHW Programs.

---

Authorizing Statute(s): US Code: 42 USC 293 Name of Law: Health Professions Education Partnerships Act
  

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:
	87 FR 31893	05/25/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 58359	09/26/2022
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Program Specific Form	1	Program Specific Form
Scholarships for Disadvantaged Students Program Specific Data Forms	2	Scholarships for Disadvantaged Students Program Specific Data Forms

---

ICR Summary of Burden

	Total Request	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	2,392	0	0	2,392	0	0
Annual Time Burden (Hours)	38,979	0	0	38,979	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: The burden in this collection has increased, due to this being a new collection.

---

Annual Cost to Federal Government: $33,027

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: 09/29/2022

---