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View ICR - OIRA Conclusion

OMB Control No: 0917-0006	ICR Reference No: 202003-0917-001
Status: Historical Active	Previous ICR Reference No: 201609-0917-001
Agency/Subagency: HHS/IHS	Agency Tracking No: 19731
Title: Application for Participation in the IHS 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 with change	Conclusion Date: 10/01/2020
	Date Received in OIRA: 03/30/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2023	36 Months From Approved	09/30/2020
Responses	3,275	0	12,580
Time Burden (Hours)	1,286	0	4,340
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	3,275	12,580	145	-9,450
Annual Time Burden (Hours)	1,286	4,340	751	-3,805
Annual Cost Burden (Dollars)	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: Yes

Burden Reduction Due to: Changing Forms

Short Statement: The online application process decreased the number of scholars completing hard copy forms IHS-856-3, IHS-856-5, and IHS-856-6. While IHS has incorporated these forms in the online application process (i.e., forms IHS- 856-3, IHS-856-5 and IHS-856-6) the applicants still need to provide this information as part of the online, electronic application.

Annual Cost to Federal Government: $145,223

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. Yes

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. Yes

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

Agency Contact: Evonne Bennett-Barnes 301 443-4750 evonne.bennett-barnes@ihs.gov

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