Reference Request for Applicants to the U.S. Public Health Service Commissioned Corps

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form PHS-50 APPLICATION FOR APPOINTMENT AS A COMMISSIONED OFFICER IN THE COMMISSIONED CORPS OF THE U.S. PUBLIC HEALTH SERVICE	Form and Instruction	Modified	Available
Form PHS-50 PHS-50	Form and Instruction	Modified	Repair queued
Form PHS-1813 REFERENCE REQUEST FOR APPLICANTS TO THE PUBLIC HEAL TH SERVICE COMMISSIONED CORPS	Form	Modified	Available
Form PHS-1813 PHS-1813	Form	Modified	Repair queued
SS-A 0937-0025 PHS 50 and PHS 1813 revised (6).docx	Supporting Statement A	Uploaded 2023-12-29	Repair queued
2023-27974 60 Day Notice 2023.pdf	Supplementary Document	Uploaded 2023-12-29	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7733	PHS-50	Form and Instruction	Modified	APPLICATION FOR APPOINTMENT AS A COMMISSIONED OFFICER IN THE COMMISSIONED CORPS OF THE U.S. PUBLIC HEALTH SERVICE
7733	PHS-50	Form and Instruction	Modified
46578	PHS-1813	Form	Modified	REFERENCE REQUEST FOR APPLICANTS TO THE PUBLIC HEAL TH SERVICE COMMISSIONED CORPS
46578	PHS-1813	Form	Modified
223158	Addendum: Commissioned Corps Personal Statement	Other-Personal Statement	Modified
193548	Interested Health Professionals		Unchanged

ICR Details

OMB Control No: 0937-0025	ICR Reference No: 202312-0937-001
Status: Active	Previous ICR Reference No: 202008-0937-001
Agency/Subagency: HHS/OASH	Agency Tracking No:
Title: Reference Request for Applicants to the U.S. Public Health Service Commissioned Corps
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/07/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/29/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2027	36 Months From Approved	02/29/2024
Responses	17,500	0	17,500
Time Burden (Hours)	3,792	0	3,792
Cost Burden (Dollars)	42,000	0	42,000

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Abstract: The Commissioned Corps of the U.S. Public Health Service has a need for the information in order to assess the qualifications of each applicant and make a determination whether the applicant meets the requirements to receive a commission. The information is used to make determinations on candidates/applicants seeking appointment to the Regular Corps and Ready Reserve Corps to assess whether they are suitable for life in the uniformed services based upon a review of a variety of assessment factors including, but not limited to: personal adjustment, employment history, character, and a candidate's prior history of service in one of the uniformed services. Their potential for leadership as a commissioned officer and their ability to deal effectively with people is evaluated.

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Authorizing Statute(s): US Code: 37 USC 101 Name of Law: (3)
  

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:
	88 FR 69207	10/05/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 88085	12/20/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Addendum: Commissioned Corps Personal Statement
Interested Health Professionals
PHS-1813	PHS-1813	REFERENCE REQUEST FOR APPLICANTS TO THE PUBLIC HEAL TH SERVICE COMMISSIONED CORPS
PHS-50	PHS-50	APPLICATION FOR APPOINTMENT AS A COMMISSIONED OFFICER IN THE COMMISSIONED CORPS OF THE U.S. PUBLIC HEALTH SERVICE

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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	17,500	17,500	0	0	0	0
Annual Time Burden (Hours)	3,792	3,792	0	0	0	0
Annual Cost Burden (Dollars)	42,000	42,000	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: $683,060

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.     Yes

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.     Yes

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? Yes

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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: 12/29/2023

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