View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
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:
0915-0146
ICR Reference No:
201101-0915-003
Status:
Historical Active
Previous ICR Reference No:
200801-0915-002
Agency/Subagency:
HHS/HSA
Agency Tracking No:
Title:
Application for Participation in the National Health Service Corps Scholarship Program
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:
04/25/2011
Retrieve Notice of Action (NOA)
Date Received in OIRA:
01/29/2011
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2014
36 Months From Approved
04/30/2011
Responses
3,660
0
1,800
Time Burden (Hours)
7,270
0
5,400
Cost Burden (Dollars)
0
0
0
Abstract:
The National Health Service Corps (NHSC) Scholarship Program offers scholarship awards to health professions students in return for the provision of full-time clinical services in a federally designated Health Professional Shortage Area. The NHSC Scholarship application collects information to select applicants for scholarship awards. The application information is necessary in order to determine those applicants that meet award criteria specified by Federal statute and regulation.
Authorizing Statute(s):
PL:
Pub.L. 107 - 251 1533
Name of Law: Health Care Safety Net Amendments of 2002
US Code:
42 USC 254
Name of Law: National Health Service Corps
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:
75 FR 64731
10/20/2010
30-day Notice:
Federal Register Citation:
Citation Date:
75 FR 81624
12/28/2010
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
Application for Participation in the National Health Service Corps Scholarship Program
NHSC_SP_001, NHSC_SP_002
NHSC_SP_001
,
Acceptance & Declination Form
Data Collection Worksheet - School/Site Form
NHSC_SP_003
Data Collection Worksheet
Deferment Request Form - Participant Form
NHSC_SP_005
Deferment Request Form
Six-Month Service Obligation Verification Form - School/Sites Forms
NHSC_SP_004
Six-Month Service Obligation Verification Form
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
3,660
1,800
0
1,860
0
0
Annual Time Burden (Hours)
7,270
5,400
0
1,115
755
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 OMB inventory of approved burden previously contained 5,400 hours for the NHSC application. This request is for 7,270 hours, for an increase of 1,870 hours. The increase in burden is a result of revisions in the forms and addition of forms. The previous burden estimate of 3 hour per respondent has been increased to 3.5 hours per respondent to include time for obtaining transcripts, academic and non-academic references and completing the new forms.
Annual Cost to Federal Government:
$1,508,041
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
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:
Amanda Cash 301 443-0208 amanda.cash@hrsa.hhs.gov
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:
01/27/2011
An official website of the United States government
The .gov means it's official.
The site is secure.
