The Division of Independent Review Application Reviewer Recruitment Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 RRM Reviewer Registration Final to OMB	Form and Instruction	Modified	Repair queued
Draft 2026 Supporting Statement A 0915-0295_FINAL to OMB.docx	Supporting Statement A	Uploaded 2026-05-19	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6550	DIR Grant Reviewer Recruitment Form	Form and Instruction	Modified	RRM Reviewer Registration Final to OMB

ICR Details

OMB Control No: 0915-0295	ICR Reference No: 202605-0915-001
Status: Active	Previous ICR Reference No: 202306-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No: 20871
Title: The Division of Independent Review Application Reviewer Recruitment Form
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: 07/16/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/19/2026
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2029	36 Months From Approved	11/30/2026
Responses	9,700	0	9,700
Time Burden (Hours)	1,727	0	1,727
Cost Burden (Dollars)	0	0	0

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Abstract: This ICR is for the extension of approval of a web-based data collection system, the Reviewer Recruitment Module (RRM), which collects applications for reviewers of eligible applications submitted for HRSA’s competitive grants. These reviewers make up the grant’s objective review panel. The purpose of this process is to ensure that application reviewers are subject matter experts knowledgeable in necessary health and public health discipline(s) to provide informed advice for HRSA programs that ultimately make funding awards. Data collected in the Application Reviewer Recruitment Form includes degree, specialty, occupation, work setting, and in select instances, affiliations with organizations and institutions that serve special populations. Some program regulations require that objective review panels contain consumers of health services. Other demographic data may be voluntarily provided by a potential reviewer. Defined data elements assist HRSA in finding and selecting expert reviewers for objective review committees.  

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Authorizing Statute(s): US Code: 42 USC 799(f) and 806(c) 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:
	91 FR 3896	01/29/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 29141	05/19/2026
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
DIR Grant Reviewer Recruitment Form	1	RRM Reviewer Registration Final to OMB

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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	9,700	9,700	0	0	0	0
Annual Time Burden (Hours)	1,727	1,727	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: $680,961

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: 05/19/2026

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