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View ICR - OIRA Conclusion

OMB Control No: 0915-0149	ICR Reference No: 201910-0915-004
Status: Historical Active	Previous ICR Reference No: 201612-0915-003
Agency/Subagency: HHS/HSA	Agency Tracking No: 20517
Title: Scholarships for Disadvantaged Students Application Program Specific Form
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: 11/26/2019
	Date Received in OIRA: 11/05/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2022	36 Months From Approved	03/31/2020
Responses	323	0	400
Time Burden (Hours)	10,013	0	5,200
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	323	400	-77
Annual Time Burden (Hours)	10,013	5,200	4,813
Annual Cost Burden (Dollars)	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: There are less respondents; respondents are now required to provide data every 3 years vs. 1 year previously. This change increases the burden to the respondents to provide more data every 3 years instead of less data every 1 year.

Annual Cost to Federal Government: $24,844

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]? Yes

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: Elyana Bowman 301 443-3983 enadjem@hrsa.gov

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