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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0937-0025
ICR Reference No:
201911-0937-001
Status:
Historical Active
Previous ICR Reference No:
201607-0937-001
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:
02/21/2020
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/27/2019
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2023
36 Months From Approved
02/29/2020
Responses
16,000
0
12,000
Time Burden (Hours)
3,500
0
4,250
Cost Burden (Dollars)
36,000
0
12,000
Abstract:
The forms will be used by individuals to apply for appointment in the U.S. Public Health Service Commissioned Corps and to obtain references as part of the application process. Information supplied on the forms will be used by appropriate Department officials to evaluate candidates for appointment.
Authorizing Statute(s):
US Code:
37 USC 101
Name of Law: (3)
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:
84 FR 56463
10/22/2019
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR 70982
12/26/2019
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
4
IC Title
Form No.
Form Name
Addendum: Commissioned Corps Personal Statement
Interested Health Professionals
PHS-1813
PHS-50
ICR Summary 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
16,000
12,000
0
4,000
0
0
Annual Time Burden (Hours)
3,500
4,250
0
-750
0
0
Annual Cost Burden (Dollars)
36,000
12,000
0
24,000
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:
Yes
Burden Reduction Due to:
Using Information Technology
Short Statement:
This is a revision request due to a program adjustment of 750 hours. Pre-Qualification questionnaire changed from 15 minutes to 10 minutes because the respondents now perform the pre-screen questionnaire electronically, prior to this process, the pre-qualification questionnaire was done through calling in and having a telephone conversation with a live person. The number of respondents increased from 1,000 to 3,000 respectively because the PHS-50, and Personal Statement became available to all interested health professionals and agencies. Prior to this change, the application was limited and available only to specific interested health professionals and agencies. A newly implemented digital application process allows all interested health professionals include: Medical, Dental, Nurse, Pharmacy, Scientist, Dietician, Therapist, Health Services, Engineer, Environmental Health and Veterinarians it increased the number of respondents from 1,000 to 3,000.
Annual Cost to Federal Government:
$221,160
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?
Uncollected
Agency Contact:
Sherette Funn-Coleman
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:
12/27/2019
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