View Information Collection Request (ICR) Package
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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:
0915-0140
ICR Reference No:
202212-0915-001
Status:
Historical Inactive
Previous ICR Reference No:
202002-0915-001
Agency/Subagency:
HHS/HSA
Agency Tracking No:
21547
Title:
NURSE Corps Loan Repayment Program
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Improperly submitted and continue
Conclusion Date:
01/03/2023
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/27/2022
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
03/31/2023
36 Months From Approved
03/31/2023
Responses
24,200
0
24,200
Time Burden (Hours)
16,450
0
16,450
Cost Burden (Dollars)
0
0
0
Abstract:
The need and purpose of this information collection is to obtain information for Nurse Corps LRP applicants and participants. The information is used to consider an applicant for a Nurse Corps LRP contract award, and to monitor a participant’s compliance with the service requirements. Individuals must submit an application in order to participate in the program. The application asks for personal, professional, educational, and financial information required to determine the applicant's eligibility to participate in the Nurse Corps LRP. The semi-annual employment verification form asks for personal and employment information to determine if a participant is in compliance with the service requirements. Respondents include professional RNs or advanced practice RNs (i.e., nurse practitioners, certified registered nurse anesthetists, certified nurse-midwives, clinical nurse -0ecialists) who are interested in participating in the Nurse Corps LRP, and official representatives at their service sites.
Authorizing Statute(s):
US Code:
42 USC 297n Section 846(a)
Name of Law: Public Health Service Act
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:
87 FR 59106
09/29/2022
30-day Notice:
Federal Register Citation:
Citation Date:
87 FR 78114
12/21/2022
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
8
IC Title
Form No.
Form Name
Authorization to Release Information Form
2
NC LRP Authorization to Release Information - Revised.docx
Confirmation of Interest Form
5-1, 5-2, 5-3, 5-4
NC LRP COI 1-Accept or Decline Award Page - Revised.docx
,
NC LRP COI 2-Electronic Withholding Allowance Certificate Page - Revised.docx
,
NC LRP COI 3-Sign your Electronic Contract Page - Revised.docx
,
NC LRP COI 4-Submitted Landing Page - Revised.docx
Disadvantaged Background Form
4
NC LRP - DAB Form - Revised.docx
Employment Verification Form
3
NC LRP - EVF Form - Revised 3.pdf
NURSE Corps LRP Application
1
NC LRP - Application Form - Revised.docx
Nurse Corps Crtiical Shortage Facility (CSF) Verification Form
7
NC LRP CSF Employment Verification Form - Revised.docx
Nurse Corps Nurse Faculty Employment Verification Form
8
NC LRP Nurse Faculty Employment Verification Form - Revised.docx
Participant Semi-Annual in Service Verification Form
6
NCLRP & NF ISV & EV Screenshots - Revised.pptx
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:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$973,000
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]?
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?
No
Agency Contact:
Tierra Moore 301 443-0496 tmoore@hrsa.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:
12/27/2022
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