Scholarships for Disadvantaged Students Program Specific Form

Forms and Documents

Document	Type	Status	Availability
Form 1 (Redline) SDS Program Specific Data Form	Form	Modified	Available
Form 1 Scholarships for Disadvantaged Students Program Specific Data Forms	Form	Modified	Available
0906 0073_NonSubstantive Change Request.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2026-07-01	Available
SDS Supporting Statement - OMB Passback (09232025) redline.docx	Supporting Statement A	Uploaded 2025-11-18	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
256154	Scholarships for Disadvantaged Students Program Specific Data Forms	Form	Modified	SDS Program Specific Data Form
256154	Scholarships for Disadvantaged Students Program Specific Data Forms	Form	Modified	Scholarships for Disadvantaged Students Program Specific Data Forms

ICR Details

OMB Control No: 0906-0073	ICR Reference No: 202607-0906-001
Status: Received in OIRA	Previous ICR Reference No: 202508-0906-003
Agency/Subagency: HHS/HRSA	Agency Tracking No:
Title: Scholarships for Disadvantaged Students 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	Date Submitted to OIRA: 07/01/2026

	Requested	Previously Approved
Expiration Date	01/31/2029	01/31/2029
Responses	500	340
Time Burden (Hours)	7,000	4,760
Cost Burden (Dollars)	0	0

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Abstract: The Health Resources and Services Administration (HRSA) seeks to collect data through the Scholarships for Disadvantaged Students (SDS) Program Specific Form. This data collection is essential for HRSA to advance its mission and close critical data gaps in program performance and long-term sustainability. The information will be collected from institutions that apply for SDS program awards. HRSA will use this information to: • Assess applicants' experience, need, and performance in strengthening the health workforce • Evaluate service and progress in serving target populations • Help grant reviewers and policymakers make informed decisions • Determine eligibility for the SDS program

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Authorizing Statute(s): US Code: 42 USC 293a Name of Law: Scholarships for disadvantaged students
  

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:
	90 FR 22494	05/28/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 39399	08/15/2025
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Scholarships for Disadvantaged Students Program Specific Data Forms	1 (Redline), 1	Scholarships for Disadvantaged Students Program Specific Data Forms ,   SDS Program Specific Data Form

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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	500	340	0	160	0	0
Annual Time Burden (Hours)	7,000	4,760	0	2,240	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: Initial Approved Package: HRSA will move the BHW Program Specific Data Form to another ICR that reports data outcomes post grant award. As for average burden per response for the SDS Program Specific Form, SDS program staff conducted burden testing performed by eight grantees regarding the format, content of data to be collected, and time to complete the application and report. The SDS Program Specific Form was reduced from sixteen sections to seven sections. The program staff calculated the time for completion of the revised form at 14 hours based upon program experience and past grant recipient comments. Non-Substantive Change Request: During OMB review, HRSA updated the total number of respondents in the Supporting Statement A to reflect updated totals from the FY 2025 application cycle (the previous numbers reflected the FY 2020 application cycle). The purpose of this request is to make the same change in the burden table in ROCIS.

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Annual Cost to Federal Government: $189,323

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: 07/01/2026

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